Individual
MS. ANITA EILEEN MCCULLOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2105 CRUMS LN, SUITE 8, LOUISVILLE, KY 40216-4231
(502) 693-5870
Mailing address
101 W MUHAMMAD ALI BLVD, SUITE 8, LOUISVILLE, KY 40202-1423
(502) 586-8600
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3141
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30615058
—
KY
Enumeration date
01/11/2007
Last updated
03/15/2016
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