Provider Demographics
NPI:1295479582
Name:MCCULLOUGH, ALLYN NICHOLE (LISW-S)
Entity type:Individual
Prefix:
First Name:ALLYN
Middle Name:NICHOLE
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:ALLYN
Other - Middle Name:N
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4041 N HIGH ST STE 203B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3248
Mailing Address - Country:US
Mailing Address - Phone:614-226-4875
Mailing Address - Fax:
Practice Address - Street 1:4041 N HIGH ST STE 203B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3248
Practice Address - Country:US
Practice Address - Phone:614-226-4875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-23
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.18011911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical