Healthcare Provider Details

I. General information

NPI: 1073312682
Provider Name (Legal Business Name): YVETTE MCCULLOUGH FAMILY SERVICES CASE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2025
Last Update Date: 03/08/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 CHAMPIONS DR
BRIDGEVILLE DE
19933-2438
US

IV. Provider business mailing address

125 CHAMPIONS DRIVE PO BOX 51
BRIDGEVILLE DE
19933-2438
US

V. Phone/Fax

Practice location:
  • Phone: 302-390-0477
  • Fax:
Mailing address:
  • Phone: 443-206-5501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number27S2XJ
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: