Provider Demographics
NPI:1548786379
Name:CULPEPPER, JOANN MCCULLOUGH (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:MCCULLOUGH
Last Name:CULPEPPER
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3686 US HIGHWAY 331 S
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32435-8463
Mailing Address - Country:US
Mailing Address - Phone:850-892-8045
Mailing Address - Fax:850-892-8039
Practice Address - Street 1:3686 US HIGHWAY 331 S
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32435-8463
Practice Address - Country:US
Practice Address - Phone:850-892-8045
Practice Address - Fax:850-892-8039
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14688104100000X, 1041C0700X
FLSW146881041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1548786379Medicaid