Individual
WILLIE MCCULLOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
23751 COYLE ST, OAK PARK, MI 48237-1929
(248) 506-5891
Mailing address
22590 PEMBROKE AVE, DETROIT, MI 48219-1158
(313) 574-7976
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
261QA0600X
MI
101YM0800X
Mental Health Counselor
6401013637
MI
Other
Enumeration date
08/13/2015
Last updated
08/13/2015
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