Provider Demographics
NPI:1477154508
Name:MULLINS, MACKENZIE ELIZABETH JUNE
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:ELIZABETH JUNE
Last Name:MULLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 ASHTON CT APT 173
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-7602
Mailing Address - Country:US
Mailing Address - Phone:567-644-2317
Mailing Address - Fax:
Practice Address - Street 1:312 MAJOR KING LN
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-4797
Practice Address - Country:US
Practice Address - Phone:567-644-2317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst