Provider Demographics
NPI:1346269842
Name:MULLINS, MERLE L (LCSW)
Entity Type:Individual
Prefix:
First Name:MERLE
Middle Name:L
Last Name:MULLINS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 COUNTRYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-2801
Mailing Address - Country:US
Mailing Address - Phone:717-233-6877
Mailing Address - Fax:717-233-2828
Practice Address - Street 1:4000 DERRY ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-2237
Practice Address - Country:US
Practice Address - Phone:717-233-6877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0129011041C0700X
PAMF000083106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical