Provider Demographics
NPI:1932740503
Name:MCCULLOCH, SIERRA (LCSW)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:MCCULLOCH
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 1:2133 MARKET ST STE 220
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-4718
Mailing Address - Country:US
Mailing Address - Phone:717-496-5729
Mailing Address - Fax:
Practice Address - Street 1:2133 MARKET ST STE 220
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4718
Practice Address - Country:US
Practice Address - Phone:717-496-5729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA$$$$$$$$$Medicaid