Healthcare Provider Details

I. General information

NPI: 1225004633
Provider Name (Legal Business Name): LAWRENCE CULL JR. PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 HOWARD GAP RD
FLETCHER NC
28732-9560
US

IV. Provider business mailing address

310 OVERLOOK RD STE B
ASHEVILLE NC
28803-3319
US

V. Phone/Fax

Practice location:
  • Phone: 828-483-4330
  • Fax: 828-483-5417
Mailing address:
  • Phone: 828-438-5788
  • Fax: 828-333-5360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number71-006421
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: