Provider Demographics
NPI:1881241107
Name:MCCALL, COREATHEA RENEE (PSY D)
Entity type:Individual
Prefix:DR
First Name:COREATHEA
Middle Name:RENEE
Last Name:MCCALL
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:DR
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:MCCALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:2501 HUNTER PL STE 201
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-3940
Mailing Address - Country:US
Mailing Address - Phone:571-526-5981
Mailing Address - Fax:
Practice Address - Street 1:2501 HUNTER PL STE 201
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-3940
Practice Address - Country:US
Practice Address - Phone:571-526-5981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling