Provider Demographics
NPI:1144889684
Name:MULLAN, CHRISTINE (LMSW)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:MULLAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:OVAITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2530 LEONARD ST NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-3758
Mailing Address - Country:US
Mailing Address - Phone:989-330-3572
Mailing Address - Fax:
Practice Address - Street 1:4175 3 MILE RD NW
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MI
Practice Address - Zip Code:49534-1133
Practice Address - Country:US
Practice Address - Phone:616-453-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-09
Last Update Date:2019-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010929821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical