Provider Demographics
NPI:1609959758
Name:MCCULLY, DAVID MITCHELL (LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MITCHELL
Last Name:MCCULLY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9567 DALE AVE
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-1405
Mailing Address - Country:US
Mailing Address - Phone:818-352-9140
Mailing Address - Fax:818-352-9140
Practice Address - Street 1:11388 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1605
Practice Address - Country:US
Practice Address - Phone:310-268-2560
Practice Address - Fax:310-235-2784
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS25561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical