Provider Demographics
NPI:1053498733
Name:CULLEN, CAROLE CELIA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:CELIA
Last Name:CULLEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9228 LINSLADE WAY
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-5023
Mailing Address - Country:US
Mailing Address - Phone:919-795-0101
Mailing Address - Fax:
Practice Address - Street 1:9228 LINSLADE WAY
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-5023
Practice Address - Country:US
Practice Address - Phone:919-795-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1106106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC141UVOtherBCBS