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General NPI Number Information
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NPI Number | 1649796327
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Entity Type | Organization
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Legal Business Name | MCCLEOD & ASSOCIATES PLLC
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Dates
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Enumeration Date | 08/15/2017
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Last Update Date | 08/15/2017
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Provider Practice Location Address
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Address Line | 1100 LOGGER COURT SUITE F100
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City | RALEIGH
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State | NC
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Zip | 27609-8525
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Country | US
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Telephone | 252-325-5189
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Fax | 919-908-9506
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Provider Business Mailing Address
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Address Line | PO BOX 91182
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City | RALEIGH
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State | NC
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Zip | 27675
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Country | US
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Telephone | 252-325-5189
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Fax | 919-908-9506
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MISS KESHAWN ADELL MCCLEOD
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Credential | LCSW
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Telephone | 252-325-5189
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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 | C005958
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License Number State | NC
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