Provider Demographics
NPI:1043598204
Name:MCLAIN, JEFFREY LYNN (CAC, LCAS)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:LYNN
Last Name:MCLAIN
Suffix:
Gender:M
Credentials:CAC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 347
Mailing Address - Street 2:1477 TED MELTON ROAD
Mailing Address - City:CHESTERFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29709-0347
Mailing Address - Country:US
Mailing Address - Phone:843-623-3077
Mailing Address - Fax:843-623-3077
Practice Address - Street 1:1477 TED MELTON ROAD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:SC
Practice Address - Zip Code:29709-0347
Practice Address - Country:US
Practice Address - Phone:843-623-3077
Practice Address - Fax:843-623-3077
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11040110101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)