Provider Demographics
NPI:1356491716
Name:CULLEY, DETHIA E (MSP, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DETHIA
Middle Name:E
Last Name:CULLEY
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 HEARTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-7478
Mailing Address - Country:US
Mailing Address - Phone:803-794-6239
Mailing Address - Fax:
Practice Address - Street 1:309 HEARTWOOD DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-7478
Practice Address - Country:US
Practice Address - Phone:803-794-6239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC937235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist