1811140106 NPI number — MS. IRENE U. MCCLELLAN LCSW, MSW

Table of content: MS. IRENE U. MCCLELLAN LCSW, MSW (NPI 1811140106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811140106 NPI number — MS. IRENE U. MCCLELLAN LCSW, MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCLELLAN
Provider First Name:
IRENE
Provider Middle Name:
U.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811140106
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3308 GLEN CURRIN DR.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-881-9478
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
820 SOUTH BOYLAN AVE
Provider Second Line Business Practice Location Address:
DOROTHEA DIX HOSPITAL
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-733-7826
Provider Business Practice Location Address Fax Number:
919-733-7439
Provider Enumeration Date:
10/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  C004179 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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