Provider Demographics
NPI:1326824772
Name:MULLIN, REBECCA BLAKE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:BLAKE
Last Name:MULLIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:BLAKE
Other - Last Name:FARIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:128 OLIVIA LN
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-2961
Mailing Address - Country:US
Mailing Address - Phone:203-297-8812
Mailing Address - Fax:
Practice Address - Street 1:128 OLIVIA LN
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-2961
Practice Address - Country:US
Practice Address - Phone:203-297-8812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-01
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6721101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional