Provider Demographics
NPI:1013294560
Name:MCLEAN, SUSAN ANN (LPC, NCC, CCH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANN
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:LPC, NCC, CCH
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ANN
Other - Last Name:OAKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:219 DORA DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-6293
Mailing Address - Country:US
Mailing Address - Phone:843-457-0946
Mailing Address - Fax:
Practice Address - Street 1:172 WACCAMAW MEDICAL PARK CT
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8965
Practice Address - Country:US
Practice Address - Phone:843-457-0946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5200101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health