Provider Demographics
NPI:1427058072
Name:MULLICE, ROSE S (LCSW)
Entity type:Individual
Prefix:MS
First Name:ROSE
Middle Name:S
Last Name:MULLICE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 HARMON AVE
Mailing Address - Street 2:1B03
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5641
Mailing Address - Country:US
Mailing Address - Phone:912-435-6732
Mailing Address - Fax:912-435-6863
Practice Address - Street 1:1061 HARMON AVE
Practice Address - Street 2:BUILDING 311
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5604
Practice Address - Country:US
Practice Address - Phone:912-435-6779
Practice Address - Fax:912-435-6863
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0024071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical