Provider Demographics
NPI:1245794858
Name:MCCLAIN, FLORINE (LLPC)
Entity Type:Individual
Prefix:MISS
First Name:FLORINE
Middle Name:
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25600 WOODWARD AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-0944
Mailing Address - Country:US
Mailing Address - Phone:313-970-6257
Mailing Address - Fax:
Practice Address - Street 1:25600 WOODWARD AVE STE 104
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-0944
Practice Address - Country:US
Practice Address - Phone:313-970-6257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016949101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health