MEDICARE: DR. SHEDRICK DWIGHT MCCALL JR. ED.D., LPC-R

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1821772120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHEDRICK DWIGHT MCCALL JR. ED.D., LPC-R

Provider Business Mailing Address
First Line	:	8813 PROCTORS RUN DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23237-2774
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6601 IRONGATE SQ STE C
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23234-6077
Country	:	US
Telephone Number	:	804-564-4173
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2023
Last Update Date	:	06/15/2023

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