Provider Demographics
NPI:1457654139
Name:CULBERTSON, PATRICIA M (MSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:CULBERTSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3476 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1485
Mailing Address - Country:US
Mailing Address - Phone:850-491-6494
Mailing Address - Fax:
Practice Address - Street 1:3476 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1485
Practice Address - Country:US
Practice Address - Phone:850-491-6494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health