Provider Demographics
NPI:1093702706
Name:MULLINS, RANDY LEE (LPC PLLC)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:LEE
Last Name:MULLINS
Suffix:
Gender:M
Credentials:LPC PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1604 ELKHART CIR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-7745
Mailing Address - Country:US
Mailing Address - Phone:704-813-2649
Mailing Address - Fax:704-867-6206
Practice Address - Street 1:825 MAJESTIC CT UNIT 8
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5186
Practice Address - Country:US
Practice Address - Phone:704-813-2649
Practice Address - Fax:704-868-9948
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC642101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103103Medicaid
NC61302OtherBCBS