Provider Demographics
NPI:1477531622
Name:MCLELLAN, WENDY M (MA, LCDP)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:M
Last Name:MCLELLAN
Suffix:
Gender:F
Credentials:MA, LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 SWEENEY LN
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-4223
Mailing Address - Country:US
Mailing Address - Phone:401-254-2569
Mailing Address - Fax:
Practice Address - Street 1:2 OLD COUNTY RD
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-1602
Practice Address - Country:US
Practice Address - Phone:401-246-1195
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILCDP00131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)