Provider Demographics
NPI:1811140106
Name:MCCLELLAN, IRENE U (LCSW, MSW)
Entity type:Individual
Prefix:MS
First Name:IRENE
Middle Name:U
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 GLEN CURRIN DR.
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612
Mailing Address - Country:US
Mailing Address - Phone:919-881-9478
Mailing Address - Fax:
Practice Address - Street 1:820 SOUTH BOYLAN AVE
Practice Address - Street 2:DOROTHEA DIX HOSPITAL
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603
Practice Address - Country:US
Practice Address - Phone:919-733-7826
Practice Address - Fax:919-733-7439
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0041791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical