Provider Demographics
NPI:1457480667
Name:MCCULLOUGH-SIMPSON, ERIKA LYNN (LPA)
Entity Type:Individual
Prefix:MRS
First Name:ERIKA
Middle Name:LYNN
Last Name:MCCULLOUGH-SIMPSON
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4900 RANDALL PKWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1798
Mailing Address - Country:US
Mailing Address - Phone:910-799-7557
Mailing Address - Fax:910-799-7558
Practice Address - Street 1:4900 RANDALL PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1798
Practice Address - Country:US
Practice Address - Phone:910-799-7557
Practice Address - Fax:910-799-7558
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1986103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107245Medicaid