Provider Demographics
NPI:1497099170
Name:CULL, STEPHANIE MICHELE (LPCC, LICDC)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:MICHELE
Last Name:CULL
Suffix:
Gender:F
Credentials:LPCC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COMMUNITY SUPPORT SERVICES, INC.
Mailing Address - Street 2:150 CROSS STREET
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44311-1026
Mailing Address - Country:US
Mailing Address - Phone:330-253-9388
Mailing Address - Fax:330-376-6726
Practice Address - Street 1:150 CROSS STREET
Practice Address - Street 2:COMMUNITY SUPPORT SERVICES, INC.
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-1026
Practice Address - Country:US
Practice Address - Phone:330-996-9141
Practice Address - Fax:330-253-0377
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH121011101YA0400X
OHLICDC.121011101YA0400X
OHE.1800948101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2584314Medicaid