Individual
DERRICK DESHAWN-MARCUS MCCULLOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
34290 FORD RD, WESTLAND, MI 48185-3051
(313) 445-2695
Mailing address
34290 FORD RD, WESTLAND, MI 48185-3051
(313) 445-2695
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6401223703
MI
Other
Enumeration date
01/09/2024
Last updated
01/11/2024
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