Provider Demographics
NPI:1740908854
Name:MCLEOD, MARK STEVEN (LCMHCA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:STEVEN
Last Name:MCLEOD
Suffix:
Gender:M
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 GOVERNMENT RD
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-7446
Mailing Address - Country:US
Mailing Address - Phone:919-389-0433
Mailing Address - Fax:
Practice Address - Street 1:109 PROFESSIONAL CT STE 108
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-8348
Practice Address - Country:US
Practice Address - Phone:919-322-0740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17850101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health