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General NPI Number Information
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NPI Number | 1346276292
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Entity Type | Individual
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Provider Name | MICHAEL W CLANCY LCPC, LCADC
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Gender | Male
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 06/17/2014
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Provider Practice Location Address
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Address Line | 10630 LITTLE PATUXENT PKWY SUITE 209
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City | COLUMBIA
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State | MD
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Zip | 21044-3273
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Country | US
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Telephone | 410-740-8066
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Fax | 410-740-8068
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Provider Business Mailing Address
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Address Line | 10630 LITTLE PATUXENT PKWY SUITE 209
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City | COLUMBIA
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State | MD
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Zip | 21044-3264
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Country | US
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Telephone | 410-740-8066
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Fax | 410-740-8068
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCA323
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LC1210
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License Number State | MD
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