Provider Demographics
NPI:1699793729
Name:MULLINS, PAMELA A (LMHC, LADC)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:A
Last Name:MULLINS
Suffix:
Gender:F
Credentials:LMHC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 GLADE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3313
Mailing Address - Country:US
Mailing Address - Phone:617-983-5398
Mailing Address - Fax:
Practice Address - Street 1:12 GLADE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3313
Practice Address - Country:US
Practice Address - Phone:617-983-5398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1886101YA0400X
MALMHC#771101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM0805OtherBCBS PROVIDER NUMBER