| Doctor Name: | MS. WANDA GRACE MCCULLOUGH |
| NPI Number: | 1083994701 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | C1197 |
| Business Practice Address: | 332 Highway 12 W Kosciusko, MS - 390903209 |
| Business Phone Number: | 6622891800 |
| Business Fax Number: | 6622899770 |
| Mailing Address: | 214 Grace Ln, FLORA |
| State: | MS |
| Postal Code: | 390716005 |
| Phone Number: | 6015002727 |
| Fax Number: | |
| NPI Enumeration Date: | 08/25/2011 |
| NPI Last Update Date: | 08/25/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | C1197 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |