Provider Demographics
NPI:1598470361
Name:MCCULLERS, MARY L
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:L
Last Name:MCCULLERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5641 QUAIL COVEY LN
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591-7901
Mailing Address - Country:US
Mailing Address - Phone:919-597-7965
Mailing Address - Fax:
Practice Address - Street 1:501 BUNN ST
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:NC
Practice Address - Zip Code:27597-9177
Practice Address - Country:US
Practice Address - Phone:919-796-5780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness