Provider Demographics
NPI:1568539674
Name:MCMULLIN, LOTONDA M (MA)
Entity Type:Individual
Prefix:MRS
First Name:LOTONDA
Middle Name:M
Last Name:MCMULLIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 ANGEL GARDEN WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-7788
Mailing Address - Country:US
Mailing Address - Phone:803-665-8164
Mailing Address - Fax:
Practice Address - Street 1:114 BARNWELL
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-1627
Practice Address - Country:US
Practice Address - Phone:803-665-8164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD101Y00000X101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor