Healthcare Provider Details

I. General information

NPI: 1013969146
Provider Name (Legal Business Name): LUZ MARTHA CALLUM ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

894 BROWNINGS CV
SHIPMAN VA
22971-2525
US

IV. Provider business mailing address

894 BROWNINGS CV
SHIPMAN VA
22971-2525
US

V. Phone/Fax

Practice location:
  • Phone: 434-826-0379
  • Fax:
Mailing address:
  • Phone: 434-826-0379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1624
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810003653
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0803000219
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: