Healthcare Provider Details

I. General information

NPI: 1952415168
Provider Name (Legal Business Name): MARK ALAN MCCLAIN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 POSTON RD SUITE 145
CHARLESTON SC
29407-3424
US

IV. Provider business mailing address

1 POSTON RD SUITE 145
CHARLESTON SC
29407-3424
US

V. Phone/Fax

Practice location:
  • Phone: 843-556-4157
  • Fax: 843-763-8747
Mailing address:
  • Phone: 843-556-4157
  • Fax: 843-763-8747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number656
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: