Provider Demographics
NPI:1154102192
Name:MCCULLOCH, SCOTT WEBSTER (LCMHCA)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:WEBSTER
Last Name:MCCULLOCH
Suffix:
Gender:M
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 MOUNT CARMEL DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-2119
Mailing Address - Country:US
Mailing Address - Phone:803-517-3488
Mailing Address - Fax:
Practice Address - Street 1:29 RAVENSCROFT DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3649
Practice Address - Country:US
Practice Address - Phone:803-517-3488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18610101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health