Provider Demographics
NPI:1528560158
Name:SINCLAIR-MCCLINTOCK, KELLY LOUISE (MA, LICDC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LOUISE
Last Name:SINCLAIR-MCCLINTOCK
Suffix:
Gender:F
Credentials:MA, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 CAPE MAY AVE
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-4348
Mailing Address - Country:US
Mailing Address - Phone:330-705-7908
Mailing Address - Fax:330-244-1106
Practice Address - Street 1:5553 FULTON DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-1728
Practice Address - Country:US
Practice Address - Phone:330-705-6989
Practice Address - Fax:330-244-1106
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH981226101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)