Provider Demographics
NPI:1225004633
Name:CULL, LAWRENCE JR (PSYD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:CULL
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 OVERLOOK RD STE B
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-3319
Mailing Address - Country:US
Mailing Address - Phone:828-438-5788
Mailing Address - Fax:828-333-5360
Practice Address - Street 1:57 HOWARD GAP RD
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732-9560
Practice Address - Country:US
Practice Address - Phone:828-483-4330
Practice Address - Fax:828-483-5417
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71-006421103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK12953Medicare PIN