Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | LCPC-3437 | ID |
Y | 101YP2500X | Professional Counselor | 0701004917 | VA |
NPI | 1003125667 |
---|---|
Provider Name | Ms. Christienne Morse Mcclure |
First Address | Manassas, VA 20110-5038 |
Second Address | Manassas, VA 20110-5038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2010 |
Last Update Date | 20/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12159648 | CAQH (01) |