Provider Demographics
NPI:1437345121
Name:MULLEN, DORA MAE (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:DORA
Middle Name:MAE
Last Name:MULLEN
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12024 JASMINE COVE WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8042
Mailing Address - Country:US
Mailing Address - Phone:919-609-0935
Mailing Address - Fax:919-556-9377
Practice Address - Street 1:12024 JASMINE COVE WAY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8042
Practice Address - Country:US
Practice Address - Phone:919-609-0935
Practice Address - Fax:919-556-9377
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0042801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106596Medicaid