Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 0803000219 | VA |
N | 103T00000X | Psychologist | 0803000219 | VA |
N | 102L00000X | Psychologist | 1624 | OR |
N | 103T00000X | Psychologist | 1624 | OR |
N | 103G00000X | Clinical Psychologist | 0810003653 | VA |
N | 103TC0700X | Clinical Psychologist | 0810003653 | VA |
NPI | 1013969146 |
---|---|
Provider Name | Dr. Luz Martha Callum |
First Address | Shipman, VA 22971-2525 |
Second Address | Shipman, VA 22971-2525 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 08/07/2007 |