Provider Demographics
NPI:1780219642
Name:MCCLELLAND, ALEX FLINT (LSATP)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:FLINT
Last Name:MCCLELLAND
Suffix:
Gender:M
Credentials:LSATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 CLARY PRESTON DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1680
Mailing Address - Country:US
Mailing Address - Phone:423-268-4748
Mailing Address - Fax:
Practice Address - Street 1:904 W LADIES MILE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-2520
Practice Address - Country:US
Practice Address - Phone:804-613-4976
Practice Address - Fax:804-799-1533
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0718000467101YA0400X
VA0704012886101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)