Provider Demographics
NPI:1245505205
Name:MCCLAY, CHAVONNE
Entity type:Individual
Prefix:
First Name:CHAVONNE
Middle Name:
Last Name:MCCLAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHAVONNE
Other - Middle Name:
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7520 MONTGOMERY BLVD NE BLDG E15
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1586
Mailing Address - Country:US
Mailing Address - Phone:505-226-6380
Mailing Address - Fax:505-214-5852
Practice Address - Street 1:7520 MONTGOMERY BLVD NE BLDG E15
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1586
Practice Address - Country:US
Practice Address - Phone:505-226-6380
Practice Address - Fax:505-214-5852
Is Sole Proprietor?:No
Enumeration Date:2012-03-09
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
PACW0178101041C0700X
NMC-092591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)