Provider Demographics
NPI:1427003367
Name:MCCLUNG, JUDITH ODESSA (MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ODESSA
Last Name:MCCLUNG
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 WATERS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-8474
Mailing Address - Country:US
Mailing Address - Phone:828-712-3469
Mailing Address - Fax:828-645-8463
Practice Address - Street 1:32 CLAYTON ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2424
Practice Address - Country:US
Practice Address - Phone:828-712-3469
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC679101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105024Medicaid