Provider Demographics
NPI:1851090872
Name:MCCULLOUGH, TOSHA RENEE (MSW)
Entity type:Individual
Prefix:
First Name:TOSHA
Middle Name:RENEE
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-3364
Mailing Address - Country:US
Mailing Address - Phone:202-679-5536
Mailing Address - Fax:
Practice Address - Street 1:8411 PENNELL ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4505
Practice Address - Country:US
Practice Address - Phone:703-504-7924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical