Basic Information
| Provider Information | |||||||||
| NPI: | 1497105407 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CULLER | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 603086 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282603086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368022000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1208 EASTCHESTER DR | ||||||||
| Address2: | STE 107 | ||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272653170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368022900 | ||||||||
| FaxNumber: | 3368022901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2016 | ||||||||
| LastUpdateDate: | 06/21/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | P010495 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.