Provider Demographics
NPI:1609265412
Name:CLIFFORD-MULLIS, SARAH (EDS)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:CLIFFORD-MULLIS
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:CLIFFORD-MULLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDS
Mailing Address - Street 1:1132 RUTHERFORD RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-3927
Mailing Address - Country:US
Mailing Address - Phone:864-250-0005
Mailing Address - Fax:864-250-0028
Practice Address - Street 1:1132 RUTHERFORD RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-3927
Practice Address - Country:US
Practice Address - Phone:864-250-0005
Practice Address - Fax:864-250-0028
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3563103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3563OtherLICENSED PSYCHO-EDUCATIONAL SPECIALIST