Wanda Grace McCullough, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C1197 Issued in MS

Practice address

332 Highway 12 W
Kosciusko, MS 39090-3209

Phone

(662) 289-1800

Fax

(662) 289-9770

NPI assigned

Aug 25, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Wanda Grace Sharp Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1314230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314230400000",
    "number": "1083994701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 GRACE LN",
            "city": "FLORA",
            "state": "MS",
            "postal_code": "390716005",
            "telephone_number": "601-500-2727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "332 HIGHWAY 12 W",
            "city": "KOSCIUSKO",
            "state": "MS",
            "postal_code": "390903209",
            "telephone_number": "662-289-1800",
            "fax_number": "662-289-9770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "WANDA",
        "middle_name": "GRACE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-08-25",
        "last_updated": "2011-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MS",
            "license": "C1197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "WANDA",
            "last_name": "SHARP",
            "middle_name": "GRACE",
            "prefix": "MS.",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Rebecca Little, FNP
• Monica Lopez
• Aubrey Manning
• John David Martin, PHARMD.
• Alanna Brooke Massey
• Tammy McGee, P.T
• Chelsey McLendon
• Tina D McNeal, PT
• Melinda J Meacham, CFNP
• Anna Taylor Middleton, OD

• Clinical Social Worker in Kosciusko, MS
• Providers in Kosciusko, MS by specialty
• Clinical Social Worker in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.