Individual
MARY KATHLEEN CATES CULLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCAC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
87001439A
IN
1041C0700X
Clinical Social Worker
Primary
34005813A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34005813A
LICENSED CLINICAL SOCIAL WORKER LICENSE
IN
Enumeration date
07/31/2025
Last updated
02/20/2026
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