Provider Demographics
NPI:1346546934
Name:MULLINS, CORY (LMSW QMRP)
Entity Type:Individual
Prefix:MR
First Name:CORY
Middle Name:
Last Name:MULLINS
Suffix:
Gender:M
Credentials:LMSW QMRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 CASS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:KEEGO HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48320-1047
Mailing Address - Country:US
Mailing Address - Phone:248-895-1455
Mailing Address - Fax:248-481-4352
Practice Address - Street 1:1711 CASS LAKE RD
Practice Address - Street 2:
Practice Address - City:KEEGO HARBOR
Practice Address - State:MI
Practice Address - Zip Code:48320-1047
Practice Address - Country:US
Practice Address - Phone:248-895-1455
Practice Address - Fax:248-481-4352
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010925511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical