Provider Demographics
NPI:1396046249
Name:HURST, PAULETTE CULBERTSON (LCAS)
Entity type:Individual
Prefix:MS
First Name:PAULETTE
Middle Name:CULBERTSON
Last Name:HURST
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 DAVID CT
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-2523
Mailing Address - Country:US
Mailing Address - Phone:704-877-9910
Mailing Address - Fax:
Practice Address - Street 1:3705 LATROBE DR
Practice Address - Street 2:SUITE 340
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4824
Practice Address - Country:US
Practice Address - Phone:704-364-3989
Practice Address - Fax:704-364-3974
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1177101YA0400X
NC202726101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)