Provider Demographics
NPI:1023250636
Name:MCCULLY, ROBERT ANDREW JR (DMIN, LPCS, LCAS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ANDREW
Last Name:MCCULLY
Suffix:JR
Gender:M
Credentials:DMIN, LPCS, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 STONECREST LN
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341-3452
Mailing Address - Country:US
Mailing Address - Phone:704-689-8882
Mailing Address - Fax:
Practice Address - Street 1:1243 E DIXON BLVD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-6978
Practice Address - Country:US
Practice Address - Phone:704-487-4000
Practice Address - Fax:704-487-4005
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1227101YA0400X
NC6825101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)