Provider Demographics
NPI:1851745988
Name:MULLIGAN, JOSEPH (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:MULLIGAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3626 STEINHAUER RD NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-4755
Mailing Address - Country:US
Mailing Address - Phone:858-248-5153
Mailing Address - Fax:
Practice Address - Street 1:1301 SHILOH RD.
Practice Address - Street 2:STE. 849
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144
Practice Address - Country:US
Practice Address - Phone:858-248-5153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0054881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical