Provider Demographics
NPI:1629211453
Name:MCCLELLAN, ADRIAN CAROL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ADRIAN
Middle Name:CAROL
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 PINE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-5358
Mailing Address - Country:US
Mailing Address - Phone:909-499-4404
Mailing Address - Fax:909-510-8182
Practice Address - Street 1:1400 E COOLEY DR STE 203
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3946
Practice Address - Country:US
Practice Address - Phone:909-499-4404
Practice Address - Fax:909-510-8182
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 133961041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health