Provider Demographics
NPI:1144926783
Name:MCMULLIN, KRYSTAL VELEKA
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:VELEKA
Last Name:MCMULLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 BULL ST STE 201
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-1906
Mailing Address - Country:US
Mailing Address - Phone:803-636-5408
Mailing Address - Fax:
Practice Address - Street 1:130 SC-HWY 252
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621
Practice Address - Country:US
Practice Address - Phone:864-231-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical