Ashley Marie McCullough, LICSW
Individual provider Active NPI Clinical Social Worker · Monkton, VT
NPI 1942976279 · NPPES record last updated Aug 17, 2021
Key facts
- NPI
- 1942976279
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 089.0134391 (VT)
- Practice address
- 4995 Silver St
Monkton, VT 05469-0546 - Phone
- (802) 734-5864
- NPI assigned
- Aug 17, 2021
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 089.0134391 | VT | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mystic Horizons, LLC | Clinical | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 089.0134391 | VT | Yes |
Addresses
Primary practice location
4995 Silver St
Monkton, VT 05469-0546
Mailing address
4995 Silver St
Hinesburg, VT 05461-9487
Phone (802) 734-5864
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 17, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.