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General NPI Number Information
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NPI Number | 1144253923
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Entity Type | Organization
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Legal Business Name | MCCULLOUGH, VARGAS, & ASSOCIATES, INC.
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 10/17/2017
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Provider Practice Location Address
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Address Line | 770 RIVERSIDE AVE STE 11
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City | ADRIAN
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State | MI
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Zip | 49221-1476
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Country | US
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Telephone | 517-264-2244
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Fax | 517-263-3325
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Provider Business Mailing Address
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Address Line | 770 RIVERSIDE AVE STE 11
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City | ADRIAN
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State | MI
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Zip | 49221-1476
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Country | US
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Telephone | 517-264-2244
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Fax | 517-263-3325
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. GERALD MCCULLOUGH
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Credential | MA, CAADC
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Telephone | 517-264-2244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 460036
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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