Provider Demographics
NPI:1164924031
Name:MCNULTY, PATRICIA A (CAC-AD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:CAC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 MARTINS GRANT CT
Mailing Address - Street 2:
Mailing Address - City:CROWNSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21032-1932
Mailing Address - Country:US
Mailing Address - Phone:410-721-6353
Mailing Address - Fax:
Practice Address - Street 1:2015 MARTINS GRANT CT
Practice Address - Street 2:
Practice Address - City:CROWNSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21032-1932
Practice Address - Country:US
Practice Address - Phone:410-721-6353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC0625101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)