Provider Demographics
NPI:1891713822
Name:MCCUNE, KATHLEEN J (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:J
Last Name:MCCUNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9097 ATLEE STATION RD
Mailing Address - Street 2:SUITE 219
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-2525
Mailing Address - Country:US
Mailing Address - Phone:804-730-2829
Mailing Address - Fax:
Practice Address - Street 1:9097 ATLEE STATION RD
Practice Address - Street 2:SUITE 219
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2525
Practice Address - Country:US
Practice Address - Phone:804-730-2829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002014103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA137427OtherANTHEM BCBS
007714785OtherMEDICAID PIN
VA117239000OtherMAGELLAN
P00069232OtherRAILROAD MEDICARE PIN
VA086879MOtherSENTARA
VA037046OtherVALUE OPTIONS
VA010094488Medicaid
VA2125514OtherALLIANCE PPO
VA037046OtherVALUE OPTIONS
VA004670C11Medicare ID - Type Unspecified
VA086879MOtherSENTARA