Provider Demographics
NPI:1770708919
Name:MCLELLAND, MICKIE SUE (MS, MAC, LCAS, LPC)
Entity type:Individual
Prefix:MS
First Name:MICKIE
Middle Name:SUE
Last Name:MCLELLAND
Suffix:
Gender:F
Credentials:MS, MAC, LCAS, LPC
Other - Prefix:
Other - First Name:MICKIE
Other - Middle Name:SUE
Other - Last Name:OHLENSCHLAEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 SUNSET HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-8567
Mailing Address - Country:US
Mailing Address - Phone:828-296-1149
Mailing Address - Fax:
Practice Address - Street 1:119 TUNNEL RD STE D
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-1800
Practice Address - Country:US
Practice Address - Phone:828-350-1000
Practice Address - Fax:828-350-1300
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC002848101Y00000X
NC917101YA0400X
MAC CERT #501886101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6111880Medicaid