Provider Demographics
NPI:1346639713
Name:MULLINS, EBOKA (PHD)
Entity Type:Individual
Prefix:DR
First Name:EBOKA
Middle Name:
Last Name:MULLINS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N CHARLES ST STE 406
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5909
Mailing Address - Country:US
Mailing Address - Phone:438-353-8754
Mailing Address - Fax:
Practice Address - Street 1:419 W REDWOOD ST STE 570
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-7023
Practice Address - Country:US
Practice Address - Phone:667-214-1909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05295103T00000X
NY019927103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist