Provider Demographics
NPI:1245901214
Name:MUFFLEY, VICKI (LMHP, MA)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:
Last Name:MUFFLEY
Suffix:
Gender:F
Credentials:LMHP, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 MARSHSIDE WAY
Mailing Address - Street 2:
Mailing Address - City:BELVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28451-7418
Mailing Address - Country:US
Mailing Address - Phone:317-557-9407
Mailing Address - Fax:
Practice Address - Street 1:1055 MARSHSIDE WAY
Practice Address - Street 2:
Practice Address - City:BELVILLE
Practice Address - State:NC
Practice Address - Zip Code:28451-7418
Practice Address - Country:US
Practice Address - Phone:317-557-9407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000815A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor