Basic Information
| Provider Information | |||||||||
| NPI: | 1205026127 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCULLAR | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 620 JOHN PAUL JONES CIRCLE | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579535269 | ||||||||
| FaxNumber: | 7579536907 | ||||||||
| Practice Location | |||||||||
| Address1: | 620 JOHN PAUL JONES CIRCLE | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579535269 | ||||||||
| FaxNumber: | 7579536907 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2007 | ||||||||
| LastUpdateDate: | 03/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 5357 | TN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.