Doctor Name: | KENNETH MCCULLOUGH |
NPI Number: | 1902178080 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LADC, LCPC |
License Number: | LC197 |
Business Practice Address: | 52 Water St Suite 2 Hallowell, ME - 04347 |
Business Phone Number: | 2074303777 |
Business Fax Number: | 2076214020 |
Mailing Address: | 52 Water St, Suite 2 HALLOWELL |
State: | ME |
Postal Code: | 04347 |
Phone Number: | 2074303777 |
Fax Number: | 2076214020 |
NPI Enumeration Date: | 02/03/2012 |
NPI Last Update Date: | 12/07/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | LC197 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | ME |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |