Provider Demographics
NPI:1902348378
Name:MCLEROY, DOUGLAS S (PASTORAL COUNSELOR)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:S
Last Name:MCLEROY
Suffix:
Gender:M
Credentials:PASTORAL COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3713 RICHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2111
Mailing Address - Country:US
Mailing Address - Phone:336-288-1484
Mailing Address - Fax:336-288-0738
Practice Address - Street 1:3713 RICHFIELD RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2111
Practice Address - Country:US
Practice Address - Phone:336-288-1484
Practice Address - Fax:336-288-0738
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC78101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor