Healthcare Provider Details

I. General information

NPI: 1952450900
Provider Name (Legal Business Name): JOSEPH M MCCLUNG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8403 EARLHAM CT
CHARLOTTE NC
28277-1836
US

IV. Provider business mailing address

8403 EARLHAM CT
CHARLOTTE NC
28277-1836
US

V. Phone/Fax

Practice location:
  • Phone: 704-493-1003
  • Fax: 866-219-1960
Mailing address:
  • Phone: 704-493-1003
  • Fax: 704-537-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5212
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number5212
License Number StateNC

VIII. Authorized Official

Name: MR. JOSEPH MICHAEL MCCLUNG
Title or Position: CEO
Credential: LPC
Phone: 704-493-1003