Provider Demographics
NPI:1922762129
Name:MCLEAN, BRENDA (LCSWA)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 48714
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28331-8714
Mailing Address - Country:US
Mailing Address - Phone:910-273-0420
Mailing Address - Fax:910-864-1799
Practice Address - Street 1:2565 RAVENHILL DR STE 2C
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5414
Practice Address - Country:US
Practice Address - Phone:910-864-1799
Practice Address - Fax:910-864-9016
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0168651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical