MEDICARE: ERIC MCCLERREN LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	APC005450	GA
2	101YP2500X	Professional Counselor	0701008171	VA

General Provider Information

NPI Number	:	1265971345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC MCCLERREN LPC

Provider Business Mailing Address
First Line	:	45671 WATERLOO STATION SQ
Second Line	:
City	:	STERLING
State	:	VA
Zip	:	20166-3060
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6862 ELM ST STE 820
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22101-3868
Country	:	US
Telephone Number	:	703-677-8243
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2017
Last Update Date	:	03/13/2023

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