Provider Demographics
NPI:1083033005
Name:MCCLENDON, MONTRIC
Entity type:Individual
Prefix:
First Name:MONTRIC
Middle Name:
Last Name:MCCLENDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4898 GA HIGHWAY 315 APT 401
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-4989
Mailing Address - Country:US
Mailing Address - Phone:678-820-1862
Mailing Address - Fax:
Practice Address - Street 1:311 SEALE RD
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36869-6917
Practice Address - Country:US
Practice Address - Phone:678-820-1862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-08
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator