Provider Demographics
NPI:1023825221
Name:MCCULLOUGH, LIHAN MARIE
Entity type:Individual
Prefix:
First Name:LIHAN
Middle Name:MARIE
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LIHAN
Other - Middle Name:MARIE
Other - Last Name:MCCULLOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAGAN RODRIGUEZ
Mailing Address - Street 1:1037 CHASON RD
Mailing Address - Street 2:
Mailing Address - City:LUMBER BRIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:28357-9648
Mailing Address - Country:US
Mailing Address - Phone:910-965-2530
Mailing Address - Fax:
Practice Address - Street 1:351 WAGONER DR STE 325
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4674
Practice Address - Country:US
Practice Address - Phone:910-491-0061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst