Provider Demographics
NPI:1477895571
Name:MCLELLAN, KELLIE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:MCLELLAN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SISTER PIERRE DR
Mailing Address - Street 2:SUITE 403
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7516
Mailing Address - Country:US
Mailing Address - Phone:410-823-6408
Mailing Address - Fax:443-279-0537
Practice Address - Street 1:9520 BERGER RD
Practice Address - Street 2:SUITE 203
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1501
Practice Address - Country:US
Practice Address - Phone:410-290-6940
Practice Address - Fax:443-279-0537
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD115731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical