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General NPI Number Information
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NPI Number | 1629211453
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Entity Type | Individual
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Provider Name | ADRIAN CAROL MCCLELLAN L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 04/09/2009
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Last Update Date | 04/19/2022
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Provider Practice Location Address
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Address Line | 1400 E COOLEY DR STE 203
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City | COLTON
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State | CA
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Zip | 92324-3946
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Country | US
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Telephone | 909-499-4404
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Fax | 909-510-8182
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Provider Business Mailing Address
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Address Line | 709 PINE VALLEY RD
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City | BANNING
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State | CA
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Zip | 92220-5358
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Country | US
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Telephone | 909-499-4404
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Fax | 909-510-8182
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS 13396
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License Number State | CA
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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 | LCS 13396
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License Number State | CA
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