Basic Information
| Provider Information | |||||||||
| NPI: | 1124102488 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCULLOUGH | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | GERARDINE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D., LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 722 RICHMOND AVE | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209105224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015652434 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1221 TAYLOR ST NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200115617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024649200 | ||||||||
| FaxNumber: | 2024645730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | PRC1334 | DC | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 0701002605 | VA | N | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.