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General NPI Number Information
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NPI Number | 1437842416
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Entity Type | Individual
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Provider Name | CLARICE MCKINNON
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Gender | Female
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Dates
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Enumeration Date | 05/26/2023
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 328 GLEN ST
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City | SUMMERVILLE
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State | SC
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Zip | 29483-4653
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Country | US
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Telephone | 843-934-2697
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Fax |
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Provider Business Mailing Address
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Address Line | 1701 N QUAKER AVE APT 425B
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City | LUBBOCK
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State | TX
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Zip | 79416-2350
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Country | US
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Telephone | 325-718-8563
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-25-412847
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License Number State | SC
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