Individual
MRS. KATHRYN ELLEN MCCULLOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
825 CHALKSTONE AVE, PROVIDENCE, RI 02908-4728
(401) 456-2000
(401) 456-6744
Mailing address
120 ROTH RD, DAYVILLE, CT 06241-1416
(401) 456-2000
(401) 456-6744
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CSW1628
RI
Other
Enumeration date
10/19/2016
Last updated
10/19/2016
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