Provider Demographics
NPI:1356787899
Name:CULBERTSON, DEBRA COLE (MED, LPC, LAC, LPCS)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:COLE
Last Name:CULBERTSON
Suffix:
Gender:F
Credentials:MED, LPC, LAC, LPCS
Other - Prefix:
Other - First Name:DEE DEE
Other - Middle Name:
Other - Last Name:CULBERTSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED, LPC, LAC, LPCS
Mailing Address - Street 1:259 WINSTEAD RD
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:SC
Mailing Address - Zip Code:29696-3026
Mailing Address - Country:US
Mailing Address - Phone:864-710-4723
Mailing Address - Fax:864-752-1186
Practice Address - Street 1:455 HIGHWAY 123 STE C
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-0855
Practice Address - Country:US
Practice Address - Phone:864-710-4723
Practice Address - Fax:864-752-1186
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6903101Y00000X
SC669101YA0400X
SC3474101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1794Medicaid