Provider Demographics
NPI:1760961445
Name:MULLANEY, KATHERINE (LCSWA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:MULLANEY
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 OLEANDER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6844
Mailing Address - Country:US
Mailing Address - Phone:910-790-5921
Mailing Address - Fax:
Practice Address - Street 1:4130 OLEANDER DR STE 100
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6844
Practice Address - Country:US
Practice Address - Phone:910-790-5921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0126641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1041C0700XMedicaid