Provider Demographics
NPI:1457641631
Name:MCLEAN, KATHRYN NICOLE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:NICOLE
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8427 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-3331
Mailing Address - Country:US
Mailing Address - Phone:910-523-4501
Mailing Address - Fax:
Practice Address - Street 1:4002 1/2 OLEANDER DR
Practice Address - Street 2:SUITE 1B
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6847
Practice Address - Country:US
Practice Address - Phone:910-523-4501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-09
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8651101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104725Medicaid