Provider Demographics
NPI:1902139652
Name:JENNESS-MCCLELLAN, LINDA DAWN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:DAWN
Last Name:JENNESS-MCCLELLAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 CONGRESS RD
Mailing Address - Street 2:
Mailing Address - City:EASTOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29044-9165
Mailing Address - Country:US
Mailing Address - Phone:803-783-8000
Mailing Address - Fax:
Practice Address - Street 1:1109 CONGRESS RD
Practice Address - Street 2:
Practice Address - City:EASTOVER
Practice Address - State:SC
Practice Address - Zip Code:29044-9165
Practice Address - Country:US
Practice Address - Phone:803-783-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC834103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical