Provider Demographics
NPI:1659954956
Name:MCCULLOUGH, SARA MICHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MICHELLE
Last Name:MCCULLOUGH
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 1:2005 RAMSAY CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-9000
Mailing Address - Country:US
Mailing Address - Phone:757-663-2660
Mailing Address - Fax:
Practice Address - Street 1:921 FIRST COLONIAL RD STE 1707
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3167
Practice Address - Country:US
Practice Address - Phone:757-685-4453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040129091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical