Provider Demographics
NPI:1336455179
Name:MCLEAN, TONYA (LPC, NCC, MS)
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:LPC, NCC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E WENDOVER AVE
Mailing Address - Street 2:SUITE R
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-6871
Mailing Address - Country:US
Mailing Address - Phone:336-944-3286
Mailing Address - Fax:336-464-2697
Practice Address - Street 1:1600 E WENDOVER AVE
Practice Address - Street 2:SUITE R
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6871
Practice Address - Country:US
Practice Address - Phone:336-944-3286
Practice Address - Fax:336-464-2697
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104665Medicaid