Provider Demographics
NPI:1255480281
Name:MCCLUNG, JOSEPH MICHAEL (LPC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:MCCLUNG
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8403 EARLHAM CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-1836
Mailing Address - Country:US
Mailing Address - Phone:704-493-1003
Mailing Address - Fax:704-537-2493
Practice Address - Street 1:5501 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE 220
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8866
Practice Address - Country:US
Practice Address - Phone:704-493-1003
Practice Address - Fax:866-219-1960
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5212101YP2500X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103149Medicaid
NC6005849Medicaid