Provider Demographics
NPI:1215080981
Name:MCCLELLAND, MATTHEW STIRLING (MA)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:STIRLING
Last Name:MCCLELLAND
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-0057
Mailing Address - Country:US
Mailing Address - Phone:919-989-7463
Mailing Address - Fax:919-989-7900
Practice Address - Street 1:1329 N BRIGHTLEAF BLVD
Practice Address - Street 2:BUILDING C, SUITE C
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-7262
Practice Address - Country:US
Practice Address - Phone:919-989-7463
Practice Address - Fax:919-553-8469
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4243101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102772Medicaid