Provider Demographics
NPI:1073289468
Name:MCCULLOUGH, LAUREN ASHLEY (RBT)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:ASHLEY
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:293 INDEPENDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-5466
Mailing Address - Country:US
Mailing Address - Phone:757-490-3009
Mailing Address - Fax:877-799-3228
Practice Address - Street 1:293 INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5466
Practice Address - Country:US
Practice Address - Phone:757-490-3009
Practice Address - Fax:877-799-3228
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VABACB712925106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician