Provider Demographics
NPI:1497105407
Name:CULLER, SAMANTHA (LCSW-A)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:CULLER
Suffix:
Gender:F
Credentials:LCSW-A
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 603086
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3086
Mailing Address - Country:US
Mailing Address - Phone:336-802-2000
Mailing Address - Fax:
Practice Address - Street 1:1208 EASTCHESTER DR
Practice Address - Street 2:STE 107
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-3170
Practice Address - Country:US
Practice Address - Phone:336-802-2900
Practice Address - Fax:336-802-2901
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0104951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical