Provider Demographics
NPI:1346863487
Name:MCCLURE, MARLEEN SYLVIA (LADAC II)
Entity Type:Individual
Prefix:MISS
First Name:MARLEEN
Middle Name:SYLVIA
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:LADAC II
Other - Prefix:MISS
Other - First Name:MARLENA
Other - Middle Name:SYLVIA
Other - Last Name:MCCLURE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LADAC II
Mailing Address - Street 1:512 OLD HICKORY BLVD APT 2817
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-6110
Mailing Address - Country:US
Mailing Address - Phone:615-906-5464
Mailing Address - Fax:
Practice Address - Street 1:512 OLD HICKORY BLVD APT 2817
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-6110
Practice Address - Country:US
Practice Address - Phone:615-906-5464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-23
Last Update Date:2020-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1234101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)