Individual
NICOLE LEE MCMULLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4805 NE GLISAN ST, PORTLAND, OR 97213-2933
(503) 545-9569
Mailing address
11531 SE WASHINGTON ST, PORTLAND, OR 97216-3839
(503) 545-9569
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
A3969
OR
1041C0700X
Clinical Social Worker
A3969
OR
1041C0700X
Clinical Social Worker
Primary
L11641
OR
Other
Enumeration date
12/16/2019
Last updated
01/21/2026
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