Provider Demographics
NPI:1780439059
Name:MCLELLON, WHITNEY JACKSON (LCSW)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:JACKSON
Last Name:MCLELLON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 BENNETT RD
Mailing Address - Street 2:
Mailing Address - City:POQUOSON
Mailing Address - State:VA
Mailing Address - Zip Code:23662-1703
Mailing Address - Country:US
Mailing Address - Phone:757-342-6068
Mailing Address - Fax:
Practice Address - Street 1:1101 PROFESSIONAL DR STE B
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-3301
Practice Address - Country:US
Practice Address - Phone:757-969-8639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040167181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical