Provider Demographics
NPI:1699148981
Name:CULLINS, MARSHA DEVETTE (LCSWA, LCASA)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:DEVETTE
Last Name:CULLINS
Suffix:
Gender:F
Credentials:LCSWA, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 STONEDALE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-8251
Mailing Address - Country:US
Mailing Address - Phone:336-417-6325
Mailing Address - Fax:
Practice Address - Street 1:16 OAK BRANCH DR STE A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-2119
Practice Address - Country:US
Practice Address - Phone:336-285-7616
Practice Address - Fax:336-275-7984
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0099371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical