Provider Demographics
NPI:1962242867
Name:CULLER, ANNA (MA, LCMHCA, NCC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:CULLER
Suffix:
Gender:F
Credentials:MA, LCMHCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 GULFSTREAM CT
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-7438
Mailing Address - Country:US
Mailing Address - Phone:336-374-0771
Mailing Address - Fax:
Practice Address - Street 1:2024 REDBUD DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-6535
Practice Address - Country:US
Practice Address - Phone:704-865-8722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20003101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health