Provider Demographics
NPI:1205469335
Name:BERNARD MULLINGS, ALEICA N (BA, DIPED)
Entity type:Individual
Prefix:MRS
First Name:ALEICA
Middle Name:N
Last Name:BERNARD MULLINGS
Suffix:
Gender:F
Credentials:BA, DIPED
Other - Prefix:
Other - First Name:N.A
Other - Middle Name:NA
Other - Last Name:N.A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NA
Mailing Address - Street 1:17335 PAGONIA DR STE 109NA
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6011
Mailing Address - Country:US
Mailing Address - Phone:407-395-2566
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:17335 PAGONIA DR STE 109
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6011
Practice Address - Country:US
Practice Address - Phone:407-395-2566
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician