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General NPI Number Information
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NPI Number | 1568470532
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Entity Type | Individual
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Provider Name | MARILYN RUTH MCCLURE LCPC
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Gender | Female
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 11315 PEMBROOKE MEDICAL CENTER SUITE 112-A
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City | WALDORF
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State | MD
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Zip | 20602
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Country | US
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Telephone | 301-645-2233
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Fax | 301-645-3633
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Provider Business Mailing Address
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Address Line | 1009 NORFOLK DR
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City | LA PLATA
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State | MD
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Zip | 20646-3551
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Country | US
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Telephone | 301-645-2233
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Fax | 301-645-3633
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LC0866
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License Number State | MD
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