Provider Demographics
NPI:1134141971
Name:MULLEN, MARTHA D (LPC)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:D
Last Name:MULLEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 N PARHAM RD STE 3
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23229-3102
Mailing Address - Country:US
Mailing Address - Phone:804-432-3015
Mailing Address - Fax:855-391-0217
Practice Address - Street 1:2303 N PARHAM RD STE 3
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23229-3102
Practice Address - Country:US
Practice Address - Phone:804-432-3015
Practice Address - Fax:855-391-0217
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003809101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701003809OtherDEPARTMENT OF HEALTH PROFESSIONS