Provider Demographics
NPI:1164871612
Name:MCCULLOUGH, KERRI CHRISTINA LEGETTE (EDD, LPC, LCPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:CHRISTINA LEGETTE
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:EDD, LPC, LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 BUNKER HILL RD NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-3026
Mailing Address - Country:US
Mailing Address - Phone:202-836-7776
Mailing Address - Fax:202-563-0109
Practice Address - Street 1:7050 CHESAPEAKE RD STE 104
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-2345
Practice Address - Country:US
Practice Address - Phone:202-813-0094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC14861101Y00000X
MDLC8367101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor