Provider Demographics
NPI:1407471808
Name:MCCULLAH, SHAWNA L (LPC, CRC, CDMS)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:L
Last Name:MCCULLAH
Suffix:
Gender:F
Credentials:LPC, CRC, CDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1173
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-0873
Mailing Address - Country:US
Mailing Address - Phone:859-512-6912
Mailing Address - Fax:866-546-4270
Practice Address - Street 1:117 EUCLID ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-4909
Practice Address - Country:US
Practice Address - Phone:859-512-6912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC2002624101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional