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General NPI Number Information
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NPI Number | 1952953523
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Entity Type | Individual
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Provider Name | JILL MCCULLOCH PHD
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Gender | Female
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Dates
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Enumeration Date | 07/12/2019
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Last Update Date | 08/21/2019
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Provider Practice Location Address
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Address Line | 7910 WOODMONT AVE STE 1101
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City | BETHESDA
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State | MD
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Zip | 20814-7059
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Country | US
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Telephone | 202-486-5552
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Fax |
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Provider Business Mailing Address
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Address Line | 7910 WOODMONT AVE STE 1101
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City | BETHESDA
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State | MD
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Zip | 20814-7059
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Country | US
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Telephone | 301-221-1591
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 04555
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 04555
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License Number State | MD
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