Healthcare Provider Details

I. General information

NPI: 1083254338
Provider Name (Legal Business Name): LINTIYA DORCHELL MCCLEARY LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ROADRUNNER DR
GASTONIA NC
28052-6267
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 704-866-6290
  • Fax: 704-866-6293
Mailing address:
  • Phone: 704-874-1904
  • Fax: 704-685-4614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18716
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9092
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: