Derrick Deshawn-Marcus McCullom, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

6401223703 Issued in MI

Practice address

34290 Ford Rd
Westland, MI 48185-3051

Phone

(313) 445-2695

NPI assigned

Jan 9, 2024

Last updated

Jan 11, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1704758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704931200000",
    "number": "1447020573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34290 FORD RD",
            "city": "WESTLAND",
            "state": "MI",
            "postal_code": "481853051",
            "telephone_number": "313-445-2695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34290 FORD RD",
            "city": "WESTLAND",
            "state": "MI",
            "postal_code": "481853051",
            "telephone_number": "313-445-2695"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "33520 Birchlawn",
            "address_purpose": "LOCATION",
            "city": "Westland",
            "state": "MI",
            "postal_code": "481858906",
            "country_code": "US",
            "telephone_number": "313-445-2695",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "29548 Southfield Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Southfield",
            "state": "MI",
            "postal_code": "480762028",
            "country_code": "US",
            "telephone_number": "313-293-7460",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCULLOM",
        "first_name": "DERRICK",
        "middle_name": "DESHAWN-MARCUS",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-01-09",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MI",
            "license": "6401223703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donnie McBride Jr., LMT
• Adrienne Kay McCain
• Emily Grace McCloskey
• Norris D. McCrary, MA,LLP,CAC-1
• Bianca McCuin
• Marquita Monique McCullough, LPN
• Tricia McDowell
• Vanisha Lashawn McGee, LLMSW
• Sharon G McGehee, OTR
• Janis McGlone., LCSW

• Mental Health Counselor in Westland, MI
• Providers in Westland, MI by specialty
• Mental Health Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.