Individual
JEREMY RANDALL MULLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
4701 WRIGHTSVILLE AVENUE BLDG 1 UNIT D-4, WILMINGTON, NC 28403-2840
(910) 899-4060
Mailing address
4701 WRIGHTSVILLE AVENUE BLDG 1 UNIT D-4, WILMINGTON, NC 28403-6911
(910) 899-4060
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
103T00000X
Psychologist
Primary
4647
NC
Other
Enumeration date
04/06/2009
Last updated
04/13/2022
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