Provider Demographics
NPI:1538303599
Name:MCCLOUD COUNSELING & CONSULTING SERVICES
Entity Type:Organization
Organization Name:MCCLOUD COUNSELING & CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:704-998-1760
Mailing Address - Street 1:3243 BLACKVINE DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-4453
Mailing Address - Country:US
Mailing Address - Phone:704-998-1760
Mailing Address - Fax:
Practice Address - Street 1:3243 BLACKVINE DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-4453
Practice Address - Country:US
Practice Address - Phone:704-998-1760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0029621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1942459813OtherNPI
NC1346336153OtherNPI