Provider Demographics
NPI:1689061558
Name:MULLEN, CINDY (MS, CADC II, CCDP)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:MULLEN
Suffix:
Gender:F
Credentials:MS, CADC II, CCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 ERNEST BILES DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:GA
Mailing Address - Zip Code:30233-2229
Mailing Address - Country:US
Mailing Address - Phone:770-358-8327
Mailing Address - Fax:678-774-6955
Practice Address - Street 1:463 ERNEST BILES DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233-2229
Practice Address - Country:US
Practice Address - Phone:770-358-8327
Practice Address - Fax:678-774-6955
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-18
Last Update Date:2015-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA303101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)