Healthcare Provider Details

I. General information

NPI: 1437888609
Provider Name (Legal Business Name): DONALD MCCULLOUGH MA, LCMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 OLD DOVER RD
ROCHESTER NH
03867-3464
US

IV. Provider business mailing address

113 CROSBY RD STE 1
DOVER NH
03820-4370
US

V. Phone/Fax

Practice location:
  • Phone: 603-516-9300
  • Fax: 603-740-9179
Mailing address:
  • Phone: 603-516-9300
  • Fax: 603-740-9179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5841
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: