Provider Demographics
NPI:1861954992
Name:MCLEAN, NIA DANIELLE
Entity type:Individual
Prefix:
First Name:NIA
Middle Name:DANIELLE
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NIA
Other - Middle Name:DANIELLE
Other - Last Name:MCLEAN-JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9529 WESHURST LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2434
Mailing Address - Country:US
Mailing Address - Phone:202-360-3614
Mailing Address - Fax:
Practice Address - Street 1:1300 MERCANTILE LN STE 141
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5331
Practice Address - Country:US
Practice Address - Phone:301-583-7798
Practice Address - Fax:301-583-7792
Is Sole Proprietor?:No
Enumeration Date:2019-04-06
Last Update Date:2019-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health