Healthcare Provider Details

I. General information

NPI: 1043060726
Provider Name (Legal Business Name): SOPHIA ALVARRAN MCCULLEY MSW, CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 VETERANS DR
LEXINGTON KY
40502-2235
US

IV. Provider business mailing address

1101 VETERANS DR
LEXINGTON KY
40502-2235
US

V. Phone/Fax

Practice location:
  • Phone: 270-348-6198
  • Fax:
Mailing address:
  • Phone: 270-348-6198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number256803
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: