Provider Demographics
NPI:1922219146
Name:MCCLELLAN, VALERIE JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:JEAN
Last Name:MCCLELLAN
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 1:150 WOODY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8624
Mailing Address - Country:US
Mailing Address - Phone:601-209-2882
Mailing Address - Fax:
Practice Address - Street 1:624 HIGHWAY 51
Practice Address - Street 2:SUITE A
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2541
Practice Address - Country:US
Practice Address - Phone:601-209-2882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC6301101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health