Healthcare Provider Details

I. General information

NPI: 1922523919
Provider Name (Legal Business Name): GREGOIRE MCCLAIN MA LCPC CAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 08/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PATHWAYS INC 2670 CRAIN HWY SUITE 409
WALDORF MD
20601
US

IV. Provider business mailing address

PATHWASY INC 2670 CRAIN HWY SUITE 409
WALDORF MD
20601
US

V. Phone/Fax

Practice location:
  • Phone: 301-373-3065
  • Fax: 240-309-4131
Mailing address:
  • Phone: 301-373-3065
  • Fax: 240-309-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAS2698
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC1935
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC1935
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: