Provider Demographics
NPI:1134248438
Name:OCALLAGHAN, MAUEEN BLUM (LPC, LMHC)
Entity type:Individual
Prefix:
First Name:MAUEEN
Middle Name:BLUM
Last Name:OCALLAGHAN
Suffix:
Gender:F
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 CALEB RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-9660
Mailing Address - Country:US
Mailing Address - Phone:336-668-9962
Mailing Address - Fax:
Practice Address - Street 1:845 CHURCH ST N STE 208
Practice Address - Street 2:PBH
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4376
Practice Address - Country:US
Practice Address - Phone:704-305-4926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9024101YM0800X
NC4406101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health