Provider Demographics
NPI:1538637533
Name:MCCLENDON, JUWELL ASHILI (LCSW)
Entity Type:Individual
Prefix:
First Name:JUWELL
Middle Name:ASHILI
Last Name:MCCLENDON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JUWELL
Other - Middle Name:ASHILI
Other - Last Name:MCCLENDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3111 CAMINO DEL RIO N STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-5724
Mailing Address - Country:US
Mailing Address - Phone:760-871-8141
Mailing Address - Fax:
Practice Address - Street 1:3111 CAMINO DEL RIO N STE 400
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-5724
Practice Address - Country:US
Practice Address - Phone:760-871-8141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CA1002861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker