Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 04720 | MD |
Y | 103TC0700X | Clinical Psychologist | 04720 | MD |
N | 103G00000X | Clinical Psychologist | PSY461 | HI |
N | 103TC0700X | Clinical Psychologist | PSY461 | HI |
NPI | 1003990607 |
---|---|
Provider Name | Dr. Aimee E Mccullough |
First Address | Ellicott City, MD 21042-3832 |
Second Address | Columbia, MD 21046-1172 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 12/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000092858 | HMSA (01) | HI |
07140002 | (05) | HI |