Active NPI
Debra L McCullough, CAS II
- Addiction (Substance Use Disorder) Counselor
- Anaheim, CA
National Provider Identifier
1871907931
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 01-999986
- Practice address
- 321 N State College Blvd
Anaheim, CA 92806-2915 - Phone
- (714) 687-0077
- Fax
- (714) 687-0691
- NPI assigned
- Jun 17, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 01-999986 | CA | Primary |
Addresses
Primary practice location
321 N State College Blvd
Anaheim, CA 92806-2915
Mailing address
321 N State College Blvd
Anaheim, CA 92806-2915
Phone (714) 687-0077
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3028 | Other | CA | ADAS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01-999986 | CA | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Heritage House North | Past | Accepting new patients | |
| Southern California Alcohol & Drug Programs, Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Substance Abuse Rehabilitation Facility
- Anaheim, CA
- NPI 1376782656
-
dba Heritage House North
- Children's Substance Abuse Rehabilitation Facility
- Anaheim, CA
- NPI 1407946304
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402963200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402963200000",
"number": "1871907931",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "321 N STATE COLLEGE BLVD",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928062915",
"telephone_number": "714-687-0077",
"fax_number": "714-687-0691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "321 N STATE COLLEGE BLVD",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928062915",
"telephone_number": "714-687-0077",
"fax_number": "714-687-0691"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCULLOUGH",
"first_name": "DEBRA",
"middle_name": "L",
"credential": "CAS II",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-06-17",
"last_updated": "2014-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "01-999986",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ADAS",
"identifier": "3028",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anaheim, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.