Provider Demographics
NPI:1003125667
Name:MCCLURE, CHRISTIENNE MORSE (LPC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTIENNE
Middle Name:MORSE
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9254 MOSBY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-5038
Mailing Address - Country:US
Mailing Address - Phone:703-895-5208
Mailing Address - Fax:888-509-0859
Practice Address - Street 1:9254 MOSBY ST
Practice Address - Street 2:SUITE B
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-5038
Practice Address - Country:US
Practice Address - Phone:703-895-5208
Practice Address - Fax:888-509-0859
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-3437101YM0800X
VA0701004917101YP2500X
IDLMFT-3076106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12159648OtherCAQH