Provider Demographics
NPI:1235607540
Name:MCCOULL, WILLIAM RYAN (LPC, LSATP)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RYAN
Last Name:MCCOULL
Suffix:
Gender:M
Credentials:LPC, LSATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 VISTA HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:RUCKERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22968-9510
Mailing Address - Country:US
Mailing Address - Phone:804-723-6463
Mailing Address - Fax:804-482-0911
Practice Address - Street 1:106 VISTA HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:RUCKERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22968-9510
Practice Address - Country:US
Practice Address - Phone:804-723-6463
Practice Address - Fax:804-482-0911
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007443101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701007443Medicaid