Provider Demographics
NPI:1073312682
Name:MCCULLOUGH, YVETTE (FAMILY SERVICES CASE)
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:
Last Name:MCCULLOUGH
Suffix:
Gender:
Credentials:FAMILY SERVICES CASE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 CHAMPIONS DRIVE
Mailing Address - Street 2:PO BOX 51
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19933-2438
Mailing Address - Country:US
Mailing Address - Phone:443-206-5501
Mailing Address - Fax:
Practice Address - Street 1:125 CHAMPIONS DR
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:DE
Practice Address - Zip Code:19933-2438
Practice Address - Country:US
Practice Address - Phone:302-390-0477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-08
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE27S2XJ2084B0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEUZQ4-5GVVXSOther27S2XJ