Provider Demographics
NPI:1922037233
Name:MCCULLEY, MARION VICTORIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARION
Middle Name:VICTORIA
Last Name:MCCULLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:M.
Other - Middle Name:VICTORIA
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1223 HUMBOLDT ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-2413
Mailing Address - Country:US
Mailing Address - Phone:303-819-2431
Mailing Address - Fax:720-956-2313
Practice Address - Street 1:1650 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-1407
Practice Address - Country:US
Practice Address - Phone:303-819-2431
Practice Address - Fax:720-956-2313
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9924201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17853869Medicaid
Q46097Medicare UPIN
CO17853869Medicaid