Provider Demographics
NPI:1902550288
Name:MULLINS, TESA (LCSW)
Entity Type:Individual
Prefix:
First Name:TESA
Middle Name:
Last Name:MULLINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5705 LYNNHAVEN PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-9157
Mailing Address - Country:US
Mailing Address - Phone:740-577-6363
Mailing Address - Fax:
Practice Address - Street 1:4313 NEW ORLEANS WAY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-1537
Practice Address - Country:US
Practice Address - Phone:740-577-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040137171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical