Provider Demographics
NPI:1265785117
Name:MCCULLOUHG, CAROLYN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:
Last Name:MCCULLOUHG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 N STEMMONS FWY STE 3010I
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-3927
Mailing Address - Country:US
Mailing Address - Phone:214-432-8296
Mailing Address - Fax:214-203-0803
Practice Address - Street 1:8500 N STEMMONS FWY STE 3010I
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-3927
Practice Address - Country:US
Practice Address - Phone:214-432-8296
Practice Address - Fax:214-203-0803
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12479104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical