Healthcare Provider Details

I. General information

NPI: 1346664612
Provider Name (Legal Business Name): MRS. SHAINA LAVETTE MCCLURE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHAINA MELTON

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N JOHNSON AVE SUITE 101
EL CAJON CA
92020-1650
US

IV. Provider business mailing address

1400 N JOHNSON AVE SUITE 101
EL CAJON CA
92020-1650
US

V. Phone/Fax

Practice location:
  • Phone: 619-461-4871
  • Fax: 619-442-1101
Mailing address:
  • Phone: 619-461-4871
  • Fax: 619-442-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: