Most Relevant Information
Provider Data
| NPI Number: | 1003385725 |
| Provider Name: | KRYSTAL MARIE MCCULLEN MSW, LCSW |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | C011536 |
Most Important Dates
| Enumeration Date: | 11/26/2018 |
| Last Updated: | 11/26/2018 |
Provider Practice Location
208 WEST DL INGRAM AVENUE
CANNON AFB
NM
881035014
Practice Location Phone/Fax
| Phone: | 2103413336 |
| Fax: |
Provider Mailing Location
203 WINN ST
MOUNT OLIVE
NC
283651826
Provider Mailing Phone/Fax
| Phone: | 9193944041 |
| Fax: |