Healthcare Provider Details

I. General information

NPI: 1912255878
Provider Name (Legal Business Name): MEGAN LEIGH MCCORMICK PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. MEGAN MCCORMICK KING

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

2115 WISCONSIN AVE NW STE 200
WASHINGTON DC
20007-2265
US

V. Phone/Fax

Practice location:
  • Phone: 678-516-1371
  • Fax:
Mailing address:
  • Phone: 202-944-5400
  • Fax: 855-771-6849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY1000801
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: