Provider Demographics
NPI:1811243959
Name:MCCULLOUGH, SHIRRIA D (LCSWA)
Entity type:Individual
Prefix:MRS
First Name:SHIRRIA
Middle Name:D
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
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Mailing Address - Street 1:2000 PERIMETER PARK DR
Mailing Address - Street 2:STE 200
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:984-215-4110
Mailing Address - Fax:
Practice Address - Street 1:3011 HWY 42 W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-8005
Practice Address - Country:US
Practice Address - Phone:252-991-3985
Practice Address - Fax:252-991-3993
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0073951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical