Provider Demographics
NPI:1619379856
Name:MCLEAN, KOZMA HOSKINS (MS, LPC-QS, LCAS-A,)
Entity Type:Individual
Prefix:
First Name:KOZMA
Middle Name:HOSKINS
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:MS, LPC-QS, LCAS-A,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 FAIRLEY ST STE B
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-3612
Mailing Address - Country:US
Mailing Address - Phone:910-610-9151
Mailing Address - Fax:888-734-8599
Practice Address - Street 1:420 FAIRLEY ST STE B
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-3612
Practice Address - Country:US
Practice Address - Phone:910-610-9151
Practice Address - Fax:888-734-8599
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10781101YM0800X
NCA10781101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1619379856Medicaid
SC405127Medicaid