Healthcare Provider Details

I. General information

NPI: 1811539554
Provider Name (Legal Business Name): LEAH DEANNA MCCULLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 PRINCESS GARDEN PKWY STE 670
LANHAM MD
20706-2957
US

IV. Provider business mailing address

5900 PRINCESS GARDEN PKWY STE 670
LANHAM MD
20706-2957
US

V. Phone/Fax

Practice location:
  • Phone: 202-560-1186
  • Fax:
Mailing address:
  • Phone: 202-560-1186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number21365
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: