Provider Demographics
NPI:1346279791
Name:MCGILLICUDY, JUDY (LPC)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:
Last Name:MCGILLICUDY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 BOSCOBEL RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-6138
Mailing Address - Country:US
Mailing Address - Phone:540-373-6829
Mailing Address - Fax:540-371-3753
Practice Address - Street 1:15 HOPE RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7202
Practice Address - Country:US
Practice Address - Phone:540-659-2725
Practice Address - Fax:540-371-3753
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002812101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA174760OtherANTHEM
VA081770OtherSENTARA
VA296497OtherMDIPA