Provider Demographics
NPI:1316007768
Name:MULLEN, CAROL (PHD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:MULLEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 MONUMENT AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-1404
Mailing Address - Country:US
Mailing Address - Phone:804-355-6876
Mailing Address - Fax:804-355-2597
Practice Address - Street 1:2910 MONUMENT AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-1404
Practice Address - Country:US
Practice Address - Phone:804-355-6876
Practice Address - Fax:804-355-2597
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000992103TC0700X
VA0717000605106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist