Provider Demographics
NPI:1093374365
Name:MULLIS, NIKI AMIA (MA, LMFTA, LCAS-A)
Entity Type:Individual
Prefix:
First Name:NIKI
Middle Name:AMIA
Last Name:MULLIS
Suffix:
Gender:F
Credentials:MA, LMFTA, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 E MOREHEAD ST STE 202B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2936
Mailing Address - Country:US
Mailing Address - Phone:704-995-0342
Mailing Address - Fax:704-943-0707
Practice Address - Street 1:1341 E MOREHEAD ST STE 202B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2936
Practice Address - Country:US
Practice Address - Phone:704-995-0342
Practice Address - Fax:704-943-0707
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24778101YA0400X
NC12219A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12229AOtherLMFTA
NCLCAS-24778OtherLCAS-A