Provider Demographics
NPI:1588493613
Name:MULLIS, SAVANNAH MARIE (LCSW-A)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:MARIE
Last Name:MULLIS
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 PARK AVE APT 2110
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-0894
Mailing Address - Country:US
Mailing Address - Phone:910-489-1285
Mailing Address - Fax:
Practice Address - Street 1:4833 CAROLINA BEACH RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2371
Practice Address - Country:US
Practice Address - Phone:910-833-7122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0209001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical