MEDICARE: MS. MICHEL MCCLAMROCK VAN DEVENDER MSW, LCSW

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
1	1041C0700X	Clinical Social Worker	C005093	NC

General Provider Information

NPI Number	:	1912183484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHEL MCCLAMROCK VAN DEVENDER MSW, LCSW

Provider Business Mailing Address
First Line	:	2124 E 5TH ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-3304
Country	:	US
Telephone Number	:	704-607-4800
Fax Number	:	704-375-0033

Provider Business Practice Location Address
First Line	:	1916 COMMONWEALTH AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-5020
Country	:	US
Telephone Number	:	704-607-4800
Fax Number	:	704-375-0033

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2008
Last Update Date	:	01/15/2008

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