Provider Demographics
NPI:1902203755
Name:MULLINS, DEANNA MAE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:MAE
Last Name:MULLINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 E SHARONS WAY APT 104
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6059
Mailing Address - Country:US
Mailing Address - Phone:207-409-4758
Mailing Address - Fax:
Practice Address - Street 1:1170 E SHARONS WAY APT 104
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6059
Practice Address - Country:US
Practice Address - Phone:207-409-4758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC148431041C0700X
IDLCSW-350991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical