Provider Demographics
NPI:1518716018
Name:KULL, CARRIE ALESE
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:ALESE
Last Name:KULL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11653 HARMONSBURG RD
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT LAKE
Mailing Address - State:PA
Mailing Address - Zip Code:16316-6333
Mailing Address - Country:US
Mailing Address - Phone:814-844-2311
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 298
Practice Address - Street 2:
Practice Address - City:ROCK CREEK
Practice Address - State:OH
Practice Address - Zip Code:44084-0298
Practice Address - Country:US
Practice Address - Phone:440-710-3209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)