Provider Demographics
NPI:1053098145
Name:MCCULLOUGH, DONNA C (LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:C
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 625
Mailing Address - Street 2:
Mailing Address - City:WEDOWEE
Mailing Address - State:AL
Mailing Address - Zip Code:36278-0625
Mailing Address - Country:US
Mailing Address - Phone:334-303-4421
Mailing Address - Fax:
Practice Address - Street 1:96 LOST CREEK COVE RD
Practice Address - Street 2:
Practice Address - City:LINEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36266-8873
Practice Address - Country:US
Practice Address - Phone:334-303-4421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLPC04130101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health