Provider Demographics
NPI:1962507533
Name:MCCULLEY, CAROL DENISE (CERT ADDICTIONS SPEC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:DENISE
Last Name:MCCULLEY
Suffix:
Gender:F
Credentials:CERT ADDICTIONS SPEC
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:DENISE
Other - Last Name:BORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1374
Mailing Address - Street 2:
Mailing Address - City:ALTURAS
Mailing Address - State:CA
Mailing Address - Zip Code:96101
Mailing Address - Country:US
Mailing Address - Phone:530-233-4209
Mailing Address - Fax:
Practice Address - Street 1:441 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ALTURAS
Practice Address - State:CA
Practice Address - Zip Code:96101
Practice Address - Country:US
Practice Address - Phone:530-233-6319
Practice Address - Fax:530-233-5311
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA03026319101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)