Provider Demographics
NPI:1427680594
Name:MCCULLOCH, DEBBIE MARIE I
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:MARIE
Last Name:MCCULLOCH
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E COTATI AVE
Mailing Address - Street 2:
Mailing Address - City:COTATI
Mailing Address - State:CA
Mailing Address - Zip Code:94931-4442
Mailing Address - Country:US
Mailing Address - Phone:707-795-4336
Mailing Address - Fax:707-795-3306
Practice Address - Street 1:420 E COTATI AVE
Practice Address - Street 2:
Practice Address - City:COTATI
Practice Address - State:CA
Practice Address - Zip Code:94931-4442
Practice Address - Country:US
Practice Address - Phone:707-795-4336
Practice Address - Fax:707-795-3306
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health