Provider Demographics
NPI:1891749651
Name:MCCLURE, KRISTEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:
Last Name:MCCLURE
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 1:1515 MOCKINGBIRD LN
Mailing Address - Street 2:SUITE 814
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3236
Mailing Address - Country:US
Mailing Address - Phone:704-525-8787
Mailing Address - Fax:704-525-8789
Practice Address - Street 1:1515 MOCKINGBIRD LN
Practice Address - Street 2:SUITE 814
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3236
Practice Address - Country:US
Practice Address - Phone:704-525-8787
Practice Address - Fax:704-525-8789
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0032941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002449Medicaid
NC138UPOtherBLUECROSSBLUESHIELD
NC6002449Medicaid