Provider Demographics
NPI:1295423978
Name:CULBERTSON, ANDREW RAY (PEER SUPPORT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:RAY
Last Name:CULBERTSON
Suffix:
Gender:M
Credentials:PEER SUPPORT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 BRUSH CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45144-9243
Mailing Address - Country:US
Mailing Address - Phone:937-549-4062
Mailing Address - Fax:
Practice Address - Street 1:990 BRUSH CREEK RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45144-9244
Practice Address - Country:US
Practice Address - Phone:937-549-4062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No251B00000XAgenciesCase Management