Jeremy Randall Mullis, MA
NPI 1922240928ActiveIndividual· Psychologist· Wilmington, NC
Psychologist (MA) in Wilmington, North Carolina, licensed in NC, with an NPI issued in April 2009. Enrolled in Medicare as practitioner - psychologist billing independently.
Overview
| NPI | 1922240928 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | MA |
| Sole proprietor | No |
| NPI issued | Apr 6, 2009 |
| Last updated in NPPES | Apr 13, 2022 |
| Certified by provider | Nov 24, 2021 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Psychologist Primary | 103T00000X | 4647 | NC |
| Counselor | 101Y00000X | — | — |
| Counselor, Addiction (Substance Use Disorder) | 101YA0400X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Psychologist Billing Independently (NC) |
|---|
Education and affiliations
| Graduation year | 2009 |
|---|---|
| Medicare specialty | Clinical Psychologist |
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