Provider Demographics
NPI:1770835878
Name:MCLEAN COUNSELING AND WELLNESS PLLC
Entity Type:Organization
Organization Name:MCLEAN COUNSELING AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:336-944-3286
Mailing Address - Street 1:1600 E WENDOVER AVE
Mailing Address - Street 2:SUITE R
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-6871
Mailing Address - Country:US
Mailing Address - Phone:336-944-3286
Mailing Address - Fax:336-464-2697
Practice Address - Street 1:1600 E WENDOVER AVE
Practice Address - Street 2:SUITE R
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6871
Practice Address - Country:US
Practice Address - Phone:336-944-3286
Practice Address - Fax:336-464-2697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPC10581251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6008850Medicaid