| Doctor Name: | MRS. SHIRLEY WALLEY MCCULLOUGH |
| NPI Number: | 1134191729 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW |
| License Number: | CSW100010 |
| Business Practice Address: | 3001 6th St Great Lakes, IL - 600882833 |
| Business Phone Number: | 8476886755 |
| Business Fax Number: | |
| Mailing Address: | Po Box 886912, GREAT LAKES |
| State: | IL |
| Postal Code: | 600886912 |
| Phone Number: | 8477266021 |
| Fax Number: | |
| NPI Enumeration Date: | 02/07/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | CSW100010 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |