Provider Demographics
NPI:1770568701
Name:MCMULLEN, DEBORAH R (PCC-SC, LICDC, LSW)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:R
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:PCC-SC, LICDC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5727 ROWENA DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-2445
Mailing Address - Country:US
Mailing Address - Phone:937-361-4834
Mailing Address - Fax:
Practice Address - Street 1:5727 ROWENA DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2445
Practice Address - Country:US
Practice Address - Phone:937-361-4834
Practice Address - Fax:937-588-5877
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021106101YA0400X
OHS 00049901041C0700X
3747P1801X
OHE 0002479101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2272231Medicaid