Provider Demographics
NPI:1467949487
Name:MULLINS, MARIE L (LCPC, CDE)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:L
Last Name:MULLINS
Suffix:
Gender:F
Credentials:LCPC, CDE
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:L
Other - Last Name:ULRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:491 WHISPERING WINDS CT
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:IL
Mailing Address - Zip Code:61548-7812
Mailing Address - Country:US
Mailing Address - Phone:309-231-8759
Mailing Address - Fax:
Practice Address - Street 1:1003 N CUMMINGS LN
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-9646
Practice Address - Country:US
Practice Address - Phone:309-444-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010003101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional