Healthcare Provider Details

I. General information

NPI: 1184459992
Provider Name (Legal Business Name): CARRIE FREDERICK MCLEAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 MARTHA LN
CLINTON NC
28328-9639
US

IV. Provider business mailing address

205 MARTHA LN
CLINTON NC
28328-9639
US

V. Phone/Fax

Practice location:
  • Phone: 910-631-1036
  • Fax: 910-483-1720
Mailing address:
  • Phone: 910-631-1036
  • Fax: 910-483-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-29815
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: