Provider Demographics
NPI:1821238049
Name:MCMULLIN, SANDRA L (LPCC-SUPV)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:MCMULLIN
Suffix:
Gender:F
Credentials:LPCC-SUPV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10216B CLEVELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-9411
Mailing Address - Country:US
Mailing Address - Phone:330-305-9100
Mailing Address - Fax:330-305-9103
Practice Address - Street 1:10216B CLEVELAND AVE NW
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-9411
Practice Address - Country:US
Practice Address - Phone:330-305-9100
Practice Address - Fax:330-305-9103
Is Sole Proprietor?:No
Enumeration Date:2009-02-27
Last Update Date:2023-04-06
Deactivation Date:2023-03-31
Deactivation Code:
Reactivation Date:2023-04-06
Provider Licenses
StateLicense IDTaxonomies
OHE.0700447-SUPV101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0244965Medicaid
OH78797000OtherOH/ID
OH0233251Medicaid