Provider Demographics
NPI:1255923074
Name:MULLINS, MIRANDA ANN (LGSW, MSW)
Entity type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:ANN
Last Name:MULLINS
Suffix:
Gender:F
Credentials:LGSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 MCDOWELL ST
Mailing Address - Street 2:
Mailing Address - City:WELCH
Mailing Address - State:WV
Mailing Address - Zip Code:24801-2225
Mailing Address - Country:US
Mailing Address - Phone:304-436-6800
Mailing Address - Fax:304-436-6803
Practice Address - Street 1:148 MCDOWELL ST
Practice Address - Street 2:
Practice Address - City:WELCH
Practice Address - State:WV
Practice Address - Zip Code:24801-2225
Practice Address - Country:US
Practice Address - Phone:304-436-6800
Practice Address - Fax:304-436-6803
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker