Provider Demographics
NPI:1851073795
Name:MCCLEAN, SHADALIA TIAYEL (LCSW)
Entity Type:Individual
Prefix:
First Name:SHADALIA
Middle Name:TIAYEL
Last Name:MCCLEAN
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 1:15500 PARKGATE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-7389
Mailing Address - Country:US
Mailing Address - Phone:804-892-1739
Mailing Address - Fax:
Practice Address - Street 1:15500 PARKGATE DR
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-7389
Practice Address - Country:US
Practice Address - Phone:804-892-1739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040155381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical