Provider Demographics
NPI:1003256041
Name:MCCULLOUGH STRIVES
Entity Type:Organization
Organization Name:MCCULLOUGH STRIVES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:PENNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:8033862395
Authorized Official - Phone:803-386-2395
Mailing Address - Street 1:160 NORTHLAKE DR
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-9384
Mailing Address - Country:US
Mailing Address - Phone:803-386-2395
Mailing Address - Fax:
Practice Address - Street 1:160 NORTHLAKE DR
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-9384
Practice Address - Country:US
Practice Address - Phone:803-386-2395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5390251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health