Individual
BETTINA MCCULLOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
904 EAST MARTIN LUTHER KING DRIVE, CENTRALIA, IL 62801
(618) 533-1391
Mailing address
904 EAST MARTIN LUTHER KING DRIVE, CENTRALIA, IL 62801
(618) 533-1391
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
104100000X
Social Worker
—
—
Other
Enumeration date
03/10/2015
Last updated
03/10/2015
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