Provider Demographics
NPI:1801978903
Name:MULLENS, THOMAS D (LMSW, CAADC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:D
Last Name:MULLENS
Suffix:
Gender:M
Credentials:LMSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:579 LAWNDALE CT
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4731
Mailing Address - Country:US
Mailing Address - Phone:616-403-0783
Mailing Address - Fax:
Practice Address - Street 1:579 LAWNDALE CT
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-4731
Practice Address - Country:US
Practice Address - Phone:616-403-0783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical