Provider Demographics
NPI:1568265858
Name:MULLEN, RUBY (LCMHCA)
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:
Last Name:MULLEN
Suffix:
Gender:
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 RAJ DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-9384
Mailing Address - Country:US
Mailing Address - Phone:302-236-4188
Mailing Address - Fax:
Practice Address - Street 1:201 MEARLEAF PL
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-6118
Practice Address - Country:US
Practice Address - Phone:917-334-8512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA21239101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health