Healthcare Provider Details

I. General information

NPI: 1255778981
Provider Name (Legal Business Name): ANGELA C MCCLENDON LCSW, BCD, CCTP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39990 FAURE RD
HEMET CA
92544-9408
US

IV. Provider business mailing address

PO BOX 2748
HEMET CA
92546-2748
US

V. Phone/Fax

Practice location:
  • Phone: 951-708-4019
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW004788
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberCSW004788
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: