Provider Demographics
NPI:1467857110
Name:MCCLOUD ACOSTA CLINICAL SERVICES PLLC
Entity Type:Organization
Organization Name:MCCLOUD ACOSTA CLINICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCCLOUD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:704-998-1760
Mailing Address - Street 1:3719 LATROBE DR
Mailing Address - Street 2:SUITE 820
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-4861
Mailing Address - Country:US
Mailing Address - Phone:704-286-6227
Mailing Address - Fax:
Practice Address - Street 1:3719 LATROBE DR
Practice Address - Street 2:SUITE 820
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4861
Practice Address - Country:US
Practice Address - Phone:704-286-6227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YA0400X
NC7687101YP2500X
NCC0029621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1346336153OtherPLLC OWNER NPI