Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | LC3976 | MD |
N | 101YM0800X | Mental Health Counselor | LC3976 | MD |
N | 101YP2500X | Professional Counselor | LC3976 | MD |
N | 101YS0200X | School Counselor | LC3976 | MD |
NPI | 1184915704 |
---|---|
Provider Name | Ms. Jacqueline Ann Mcclure |
First Address | Jessup, MD 20794-9509 |
Second Address | Jessup, MD 20794-9509 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2011 |
Last Update Date | 29/04/2011 |