Individual
JALISA JONIQUE MCCULLOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
300 CRITTENDEN BOULEVARD BOX PSYCH, ROCHESTER, NY 14642-0001
(585) 275-3592
Mailing address
604 SUBURBAN CT APT 2, ROCHESTER, NY 14620-3837
(585) 309-2363
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
402978
NY
Other
Enumeration date
05/21/2020
Last updated
07/03/2023
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