Provider Demographics
NPI:1003170010
Name:CULBERTSON, HANNA RAE (LCSW)
Entity type:Individual
Prefix:
First Name:HANNA
Middle Name:RAE
Last Name:CULBERTSON
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 1:3031 NE STEPHENS ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-6237
Mailing Address - Country:US
Mailing Address - Phone:541-229-7089
Mailing Address - Fax:541-229-9908
Practice Address - Street 1:3031 NE STEPHENS ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-6237
Practice Address - Country:US
Practice Address - Phone:541-229-7089
Practice Address - Fax:541-229-9908
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL11694101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health