Individual
MS. WANDA GRACE MCCULLOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
332 HIGHWAY 12 W, KOSCIUSKO, MS 39090-3209
(662) 289-1800
(662) 289-9770
Mailing address
214 GRACE LN, FLORA, MS 39071-6005
(601) 500-2727
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C1197
MS
Other
Enumeration date
08/25/2011
Last updated
08/25/2011
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