Provider Demographics
NPI:1790166882
Name:MCCULLOUGH, CHERLETTE (MA RMFTI)
Entity Type:Individual
Prefix:
First Name:CHERLETTE
Middle Name:
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:MA RMFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3761 CLUBSIDE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-1487
Mailing Address - Country:US
Mailing Address - Phone:321-217-6392
Mailing Address - Fax:
Practice Address - Street 1:670 N ORLANDO AVE
Practice Address - Street 2:STE.103
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4481
Practice Address - Country:US
Practice Address - Phone:407-622-1770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health