Provider Demographics
NPI:1588917744
Name:MULLIGAN, CAROL ANNE (MSCACIII)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANNE
Last Name:MULLIGAN
Suffix:
Gender:F
Credentials:MSCACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1227 N 23RD ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6565
Mailing Address - Country:US
Mailing Address - Phone:970-549-1624
Mailing Address - Fax:970-549-1626
Practice Address - Street 1:1227 N 23RD ST
Practice Address - Street 2:SUITE 103
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6565
Practice Address - Country:US
Practice Address - Phone:970-549-1624
Practice Address - Fax:970-549-1626
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4626101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)