Provider Demographics
NPI:1487824090
Name:CULLEY, MARTHA M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:M
Last Name:CULLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 S. PARK PLACE
Mailing Address - Street 2:WELLSTAR OUTPATIENT COUNSELING SERVICES
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339
Mailing Address - Country:US
Mailing Address - Phone:770-956-6479
Mailing Address - Fax:
Practice Address - Street 1:2000 S PARK PL SE
Practice Address - Street 2:WELLSTAR OUTPATIENT COUNSELING SERVICES
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2013
Practice Address - Country:US
Practice Address - Phone:770-956-6479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0015761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical