Provider Demographics
NPI:1518187426
Name:MULLALEY, PATRICIA MICHELLE (PHD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MICHELLE
Last Name:MULLALEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3959 PENDER DR
Mailing Address - Street 2:#320
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6041
Mailing Address - Country:US
Mailing Address - Phone:703-352-3822
Mailing Address - Fax:
Practice Address - Street 1:3959 PENDER DR
Practice Address - Street 2:#320
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6041
Practice Address - Country:US
Practice Address - Phone:703-352-3822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003557103T00000X, 103TC0700X, 103TC2200X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy