Healthcare Provider Details

I. General information

NPI: 1154102192
Provider Name (Legal Business Name): SCOTT WEBSTER MCCULLOCH LCMHCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 RAVENSCROFT DR
ASHEVILLE NC
28801-3649
US

IV. Provider business mailing address

48 MOUNT CARMEL DR
ASHEVILLE NC
28806-2119
US

V. Phone/Fax

Practice location:
  • Phone: 803-517-3488
  • Fax:
Mailing address:
  • Phone: 803-517-3488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA18610
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA18610
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: