Provider Demographics
NPI:1326569583
Name:MULLAN, LORIE
Entity Type:Individual
Prefix:
First Name:LORIE
Middle Name:
Last Name:MULLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 SADER DR STE 4
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25428-3915
Mailing Address - Country:US
Mailing Address - Phone:304-278-3010
Mailing Address - Fax:
Practice Address - Street 1:119 SADER DR STE 4
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:WV
Practice Address - Zip Code:25428-3915
Practice Address - Country:US
Practice Address - Phone:304-278-3010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009448041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical