Provider Demographics
NPI:1518075084
Name:MCCLURE, F DANIEL (PHD LCP)
Entity Type:Individual
Prefix:DR
First Name:F
Middle Name:DANIEL
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:PHD LCP
Other - Prefix:DR
Other - First Name:FLOYD
Other - Middle Name:D
Other - Last Name:MCCLURE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD LCP
Mailing Address - Street 1:922 9 1/2 ST NE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902
Mailing Address - Country:US
Mailing Address - Phone:434-295-0868
Mailing Address - Fax:434-977-6323
Practice Address - Street 1:922 9 1/2 ST NE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902
Practice Address - Country:US
Practice Address - Phone:434-295-0868
Practice Address - Fax:434-977-6323
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001209103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA055741OtherANTHEM