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General NPI Number Information
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NPI Number | 1780219642
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Entity Type | Individual
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Provider Name | ALEX FLINT MCCLELLAND LSATP
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Gender | Male
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Dates
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Enumeration Date | 03/11/2020
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Last Update Date | 08/25/2023
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Provider Practice Location Address
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Address Line | 904 W LADIES MILE RD
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City | RICHMOND
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State | VA
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Zip | 23222-2520
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Country | US
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Telephone | 804-613-4976
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Fax | 804-799-1533
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Provider Business Mailing Address
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Address Line | 2650 CLARY PRESTON DR
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City | HENRICO
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State | VA
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Zip | 23233-1680
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Country | US
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Telephone | 423-268-4748
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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 | 0718000467
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0704012886
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License Number State | VA
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