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General NPI Number Information
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NPI Number | 1609348663
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Entity Type | Individual
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Provider Name | PATRICK OWEN MCCLOY LCAS
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Gender | Male
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Dates
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Enumeration Date | 12/31/2018
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Last Update Date | 12/31/2018
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Provider Practice Location Address
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Address Line | 2915 DRY PONDS RD
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City | GRANITE FALLS
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State | NC
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Zip | 28630-9652
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Country | US
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Telephone | 828-638-1434
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Fax |
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Provider Business Mailing Address
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Address Line | 2915 DRY PONDS RD
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City | GRANITE FALLS
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State | NC
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Zip | 28630-9652
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Country | US
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Telephone | 828-638-1434
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Fax |
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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 | LCAS-22971
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License Number State | NC
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