Healthcare Provider Details

I. General information

NPI: 1811854417
Provider Name (Legal Business Name): CAROLYN ALLEEN MCLAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 LAKELAND TER
JACKSON MS
39216-4702
US

IV. Provider business mailing address

2445 N CHERYL DR
JACKSON MS
39211-4908
US

V. Phone/Fax

Practice location:
  • Phone: 601-202-2293
  • Fax:
Mailing address:
  • Phone: 601-202-2293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberP0976
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: