Provider Demographics
NPI:1346336153
Name:MCCLOUD, CAROLINE B (, MSW, LCSW, BCD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:B
Last Name:MCCLOUD
Suffix:
Gender:F
Credentials:, MSW, LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 SAM NEWELL RD STE D
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5084
Mailing Address - Country:US
Mailing Address - Phone:704-998-1760
Mailing Address - Fax:866-636-7060
Practice Address - Street 1:1126 SAM NEWELL RD STE D
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5084
Practice Address - Country:US
Practice Address - Phone:704-286-6227
Practice Address - Fax:866-636-7060
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0029621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106348Medicaid