Provider Demographics
NPI:1366787459
Name:MCCULLOUGH, J ANDREW (LPC)
Entity type:Individual
Prefix:
First Name:J ANDREW
Middle Name:
Last Name:MCCULLOUGH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 W BROADWAY ST STE 300
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-5545
Mailing Address - Country:US
Mailing Address - Phone:501-372-4242
Mailing Address - Fax:
Practice Address - Street 1:628 W BROADWAY ST STE 300
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114
Practice Address - Country:US
Practice Address - Phone:501-372-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1209078101YM0800X
ARP1409066101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health