Provider Demographics
NPI:1255613485
Name:MULLINS, STACY CLARK (LCSW)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:CLARK
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 1:221 N DEERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-9444
Mailing Address - Country:US
Mailing Address - Phone:912-577-8363
Mailing Address - Fax:912-554-1665
Practice Address - Street 1:221 N DEERFIELD DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-9444
Practice Address - Country:US
Practice Address - Phone:912-577-8363
Practice Address - Fax:912-554-1665
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0044911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical