Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
N | 101YP1600X | Pastoral Counselor | ||
N | 106E00000X | Assistant Behavior Analyst |
NPI | 1003572843 |
---|---|
Provider Name | Sherese Twyana Mccullough |
First Address | Gainesville, GA 30501-1167 |
Second Address | Gainesville, GA 30501-1167 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2021 |
Last Update Date | 16/11/2021 |