Provider Demographics
NPI:1710274287
Name:MCLEAN-HICKEY, TRESSY S (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TRESSY
Middle Name:S
Last Name:MCLEAN-HICKEY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:TRESSY
Other - Middle Name:S
Other - Last Name:MCLEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:3421 HOLT ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-1225
Mailing Address - Country:US
Mailing Address - Phone:704-995-2460
Mailing Address - Fax:
Practice Address - Street 1:3421 HOLT ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-1225
Practice Address - Country:US
Practice Address - Phone:704-995-2460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0068501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007895Medicaid