Provider Demographics
NPI:1811900947
Name:MULLINS, ELIZABETH LOUISE (MSSW LCSW)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:LOUISE
Last Name:MULLINS
Suffix:
Gender:F
Credentials:MSSW LCSW
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:LOUISE
Other - Last Name:COMBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSSW BSW
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:401 HOLSTON DR
Practice Address - Street 2:NOLACHUCKEY MENTAL HEALTH CENTER
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743
Practice Address - Country:US
Practice Address - Phone:423-639-1104
Practice Address - Fax:423-636-8365
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLCSW1007104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
132695OtherVALUEOPTIONS
3066716OtherMAGELLAN PINNACLE
3066716OtherMAGELLAN NAVIGATOR
334969OtherVALUEOPTIONS GROUP
TN3920247Medicaid
3066716OtherMAGELLAN SUMMIT
7759268OtherAETNA
TN3693174Medicaid
3066716OtherMAGELLAN SUMMIT
TN3693174Medicaid