Provider Demographics
NPI:1275957664
Name:MCCLERKLIN, TERRI T
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:T
Last Name:MCCLERKLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 REGENCY PARK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-4064
Mailing Address - Country:US
Mailing Address - Phone:803-422-1577
Mailing Address - Fax:
Practice Address - Street 1:441 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4232
Practice Address - Country:US
Practice Address - Phone:803-775-5080
Practice Address - Fax:803-773-6256
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)