Provider Demographics
NPI:1477612232
Name:MCLAREN, EVERETT GERARD (EDD)
Entity Type:Individual
Prefix:
First Name:EVERETT
Middle Name:GERARD
Last Name:MCLAREN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 THE FRST
Mailing Address - Street 2:
Mailing Address - City:CROZIER
Mailing Address - State:VA
Mailing Address - Zip Code:23039-2421
Mailing Address - Country:US
Mailing Address - Phone:804-784-2641
Mailing Address - Fax:804-288-8923
Practice Address - Street 1:312 GRANITE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2144
Practice Address - Country:US
Practice Address - Phone:804-288-6734
Practice Address - Fax:804-288-8923
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701000639101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA066916OtherANTHEM BC BS
VA00190OtherVALUE OPTIONS
VA086098OtherSENTARA