Provider Demographics
NPI:1518906627
Name:MULLINS, LARITA PATRICE (LCSW-C, LICSW)
Entity Type:Individual
Prefix:
First Name:LARITA
Middle Name:PATRICE
Last Name:MULLINS
Suffix:
Gender:F
Credentials:LCSW-C, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2559 ARCHWAY LN
Mailing Address - Street 2:
Mailing Address - City:BRYANS ROAD
Mailing Address - State:MD
Mailing Address - Zip Code:20616-6165
Mailing Address - Country:US
Mailing Address - Phone:301-455-8746
Mailing Address - Fax:240-407-0430
Practice Address - Street 1:1300 MERCANTILE LN
Practice Address - Street 2:SUITE 139-S
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5327
Practice Address - Country:US
Practice Address - Phone:301-455-8746
Practice Address - Fax:240-407-0430
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD127101041C0700X
DCLC500780111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical