Provider Demographics
NPI:1053329672
Name:CULLER, KIRSTEN ALLEN (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:ALLEN
Last Name:CULLER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W MAIN ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-4973
Mailing Address - Country:US
Mailing Address - Phone:443-736-4114
Mailing Address - Fax:443-736-7982
Practice Address - Street 1:111 W MAIN ST
Practice Address - Street 2:SUITE E
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-4973
Practice Address - Country:US
Practice Address - Phone:443-736-4114
Practice Address - Fax:443-736-7982
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD126421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDO21LL718Medicare ID - Type Unspecified