Provider Demographics
NPI:1912255878
Name:MCCORMICK, MEGAN LEIGH (PHD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:LEIGH
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MEGAN
Other - Middle Name:MCCORMICK
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2115 WISCONSIN AVE NW STE 200
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-2265
Mailing Address - Country:US
Mailing Address - Phone:202-944-5400
Mailing Address - Fax:855-771-6849
Practice Address - Street 1:111 MICHIGAN AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2916
Practice Address - Country:US
Practice Address - Phone:678-516-1371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000801103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent