Provider Demographics
NPI:1750089751
Name:MULLINS, SAMANTHA MAGDALENE
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:MAGDALENE
Last Name:MULLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:MAGDALENE
Other - Last Name:MCCLIMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3339 CARPENTER CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-3223
Mailing Address - Country:US
Mailing Address - Phone:317-410-2116
Mailing Address - Fax:
Practice Address - Street 1:3339 CARPENTER CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-3223
Practice Address - Country:US
Practice Address - Phone:317-410-2116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker