Provider Demographics
NPI:1437032794
Name:MCCLINTON, DUSTIN LEE (LMBT)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:LEE
Last Name:MCCLINTON
Suffix:
Gender:M
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BOSCO DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-6801
Mailing Address - Country:US
Mailing Address - Phone:910-388-6800
Mailing Address - Fax:
Practice Address - Street 1:112 BOSCO DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-6801
Practice Address - Country:US
Practice Address - Phone:910-388-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22720225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist