Provider Demographics
NPI:1992197941
Name:MULLINS HEJDUK, SHARON R (LPC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:R
Last Name:MULLINS HEJDUK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5655 CASCADE TRL
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-9533
Mailing Address - Country:US
Mailing Address - Phone:678-896-2071
Mailing Address - Fax:
Practice Address - Street 1:5655 CASCADE TRL
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-9533
Practice Address - Country:US
Practice Address - Phone:678-896-2071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005036101YP2500X
OH0006596101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional