Provider Demographics
NPI:1033312830
Name:KILCULLEN, JOSEPH P (MS, LADC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:P
Last Name:KILCULLEN
Suffix:
Gender:M
Credentials:MS, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:GREENLAND
Mailing Address - State:NH
Mailing Address - Zip Code:03840-0086
Mailing Address - Country:US
Mailing Address - Phone:603-498-4135
Mailing Address - Fax:603-772-7534
Practice Address - Street 1:370 PORTSMOUTH AVE STE 12
Practice Address - Street 2:
Practice Address - City:GREENLAND
Practice Address - State:NH
Practice Address - Zip Code:03840-2252
Practice Address - Country:US
Practice Address - Phone:603-498-4135
Practice Address - Fax:603-772-7534
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH141101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)