Provider Demographics
NPI:1215912233
Name:CULBERTSON, GINGER O (MSW, LISW-CP)
Entity type:Individual
Prefix:MS
First Name:GINGER
Middle Name:O
Last Name:CULBERTSON
Suffix:
Gender:F
Credentials:MSW, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414-E PETTIGRU ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3164
Mailing Address - Country:US
Mailing Address - Phone:864-242-1807
Mailing Address - Fax:864-242-5515
Practice Address - Street 1:414-E PETTIGRU ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3164
Practice Address - Country:US
Practice Address - Phone:864-242-1807
Practice Address - Fax:864-242-5515
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLPC448101YP2500X
SCLISWCP661041C0700X
SCLMFT1585106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQM0183Medicaid