Provider Demographics
NPI:1477047934
Name:MULLANEY, REBECCA HARRISON (LPCA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:HARRISON
Last Name:MULLANEY
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 LARCHMONT DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2613
Mailing Address - Country:US
Mailing Address - Phone:334-470-8244
Mailing Address - Fax:
Practice Address - Street 1:8120 SIDBURY RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-7946
Practice Address - Country:US
Practice Address - Phone:334-470-8244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14004101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor