Provider Demographics
NPI:1063631935
Name:KULL, CLAYTON JAMES (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CLAYTON
Middle Name:JAMES
Last Name:KULL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10595 BELL RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1806
Mailing Address - Country:US
Mailing Address - Phone:770-622-5331
Mailing Address - Fax:
Practice Address - Street 1:10595 BELL RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-1806
Practice Address - Country:US
Practice Address - Phone:770-622-5331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0014181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical