Provider Demographics
NPI:1265572283
Name:MULLINS, ALIYA S (MA)
Entity type:Individual
Prefix:MS
First Name:ALIYA
Middle Name:S
Last Name:MULLINS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11353 LAURELWALK DR # 2433
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3006
Mailing Address - Country:US
Mailing Address - Phone:860-888-4112
Mailing Address - Fax:
Practice Address - Street 1:9811 MALLARD DR
Practice Address - Street 2:209
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3143
Practice Address - Country:US
Practice Address - Phone:240-280-1594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001540101YP2500X
MDLC2295101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD012475300Medicaid