Individual
BLAKE MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
2900 HANNAH BLVD STE 104, EAST LANSING, MI 48823-5380
(517) 253-6320
Mailing address
2900 HANNAH BLVD STE 104, EAST LANSING, MI 48823-5380
(517) 253-6320
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
6801100146
MI
1041C0700X
Clinical Social Worker
Primary
6801104012
MI
Other
Enumeration date
02/13/2018
Last updated
08/08/2023
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