Provider Demographics
NPI:1639250848
Name:CULTON, LINDA S (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:CULTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 FOX DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-7236
Mailing Address - Country:US
Mailing Address - Phone:217-373-2430
Mailing Address - Fax:217-373-2443
Practice Address - Street 1:202 W PARK STREET
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3929
Practice Address - Country:US
Practice Address - Phone:217-373-2430
Practice Address - Fax:217-373-2443
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0108361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1041CO700XOtherCLINICAL SOCIAL WORKER