Provider Demographics
NPI:1710030523
Name:MCCLELLAND, CAROL A (MA, LCMHC, LCAS, CCS)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:MCCLELLAND
Suffix:
Gender:F
Credentials:MA, LCMHC, LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 HACKBERRY LN
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-5854
Mailing Address - Country:US
Mailing Address - Phone:910-890-0030
Mailing Address - Fax:
Practice Address - Street 1:5850 FAYETTEVILLE RD STE 210
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6289
Practice Address - Country:US
Practice Address - Phone:919-590-5447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC658101YA0400X
NC4242101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6112005Medicaid