Provider Demographics
NPI:1891300752
Name:MULLIN, RITA MICHELLE (LMSW)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:MICHELLE
Last Name:MULLIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7317 35TH AVENUE CT
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-8067
Mailing Address - Country:US
Mailing Address - Phone:309-269-6476
Mailing Address - Fax:
Practice Address - Street 1:3333 155TH AVE
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:IL
Practice Address - Zip Code:61264-7607
Practice Address - Country:US
Practice Address - Phone:844-814-8885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.010772101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)