Provider Demographics
NPI:1376951640
Name:KIRSTEN A. CULLER,LCSW-C, LLC
Entity Type:Organization
Organization Name:KIRSTEN A. CULLER,LCSW-C, LLC
Other - Org Name:KIRSTEN CULLER, LCSW-C, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:CULLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C, ACSW
Authorized Official - Phone:443-736-4114
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:443-737-4114
Practice Address - Fax:443-736-7982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD126421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD554231600Medicaid
MDL718Medicare PIN