Provider Demographics
NPI:1912175563
Name:CULVER, THERESA J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:J
Last Name:CULVER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 SIERRA CT STE B6
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-7608
Mailing Address - Country:US
Mailing Address - Phone:661-274-0770
Mailing Address - Fax:661-274-9970
Practice Address - Street 1:190 SIERRA CT STE B6
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-7608
Practice Address - Country:US
Practice Address - Phone:661-274-0770
Practice Address - Fax:661-274-9970
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS218811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical