Provider Demographics
NPI:1356629646
Name:MCLEAN, DONZA DENA (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DONZA
Middle Name:DENA
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MISS
Other - First Name:DONZA
Other - Middle Name:DENA
Other - Last Name:BLACKMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:4791 RIMER ROAD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025
Mailing Address - Country:US
Mailing Address - Phone:704-900-5974
Mailing Address - Fax:
Practice Address - Street 1:5226 TIMBERTOP LANE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-7548
Practice Address - Country:US
Practice Address - Phone:704-900-5974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC007243104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker