Provider Demographics
NPI:1285253088
Name:MCLEAN, ATOSHA MONTRICE (LCMHCA)
Entity type:Individual
Prefix:
First Name:ATOSHA
Middle Name:MONTRICE
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:ATOSHA
Other - Middle Name:MONTRICE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 MACHOST DR
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-4790
Mailing Address - Country:US
Mailing Address - Phone:804-248-9407
Mailing Address - Fax:
Practice Address - Street 1:45 COMM PARK LN
Practice Address - Street 2:
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501-5490
Practice Address - Country:US
Practice Address - Phone:910-502-3388
Practice Address - Fax:919-827-8500
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-11
Last Update Date:2020-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15649101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health