Healthcare Provider Details

I. General information

NPI: 1568860484
Provider Name (Legal Business Name): CHRISTIENNE MORSE MCCLURE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9254 B MOSBY STREET
MANASSAS VA
20110
US

IV. Provider business mailing address

PO BOX 851
HAYMARKET VA
20168-0851
US

V. Phone/Fax

Practice location:
  • Phone: 703-895-5208
  • Fax: 888-509-0859
Mailing address:
  • Phone: 703-895-2522
  • Fax: 888-509-0859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number701004917
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFTI-3076
License Number StateID

VIII. Authorized Official

Name: MS. CHRISTIENNE MORSE MCCLURE
Title or Position: OWNER
Credential: LPC
Phone: 703-895-2522