Provider Demographics
NPI:1295823912
Name:MULLEN, DAVID R (MSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:MULLEN
Suffix:
Gender:M
Credentials:MSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7634 FIRETHORN DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-9215
Mailing Address - Country:US
Mailing Address - Phone:910-592-7030
Mailing Address - Fax:910-592-1630
Practice Address - Street 1:606 NORTHEAST BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2023
Practice Address - Country:US
Practice Address - Phone:910-592-7030
Practice Address - Fax:910-592-1630
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0021151041C0700X
NC3350103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical