Provider Demographics
NPI:1013540558
Name:MCKAIN, MIRIAM (MARIA)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:MCKAIN
Suffix:
Gender:F
Credentials:MARIA
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:MCKAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:6505 ROCK CRYSTAL DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:VA
Mailing Address - Zip Code:20124-2523
Mailing Address - Country:US
Mailing Address - Phone:703-474-7776
Mailing Address - Fax:
Practice Address - Street 1:6505 ROCK CRYSTAL DR
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:VA
Practice Address - Zip Code:20124-2523
Practice Address - Country:US
Practice Address - Phone:703-474-7776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040090071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical