Provider Demographics
NPI:1902217615
Name:MULLINS, CHERYL ANN (CSW)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ANN
Last Name:MULLINS
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:MRS
Other - First Name:CHERYL
Other - Middle Name:ANN
Other - Last Name:BACIGALUPO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:434 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-2342
Mailing Address - Country:US
Mailing Address - Phone:859-291-1121
Mailing Address - Fax:
Practice Address - Street 1:434 SCOTT ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-2342
Practice Address - Country:US
Practice Address - Phone:859-291-1121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4003104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker