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NPI Code Detail

MEDICARE: CARLY ALYSE MCCLINTON LPC

MEDICARE:   CARLY ALYSE MCCLINTON  LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor0701011785VA

General Provider Information

NPI Number : 1235840976
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLY ALYSE MCCLINTON LPC
Provider Business Mailing Address
First Line : 6200 LAKESIDE AVE
Second Line :
City : HENRICO
State : VA
Zip : 23228-5248
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6200 LAKESIDE AVE
Second Line :
City : HENRICO
State : VA
Zip : 23228-5248
Country : US
Telephone Number : 804-307-2801
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2022
Last Update Date : 12/13/2022

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Directions to “ CARLY ALYSE MCCLINTON LPC” Practice Location

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