Provider Demographics
NPI:1568834794
Name:MCCLURE, CAMERON DAVIS
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:DAVIS
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 AUGUSTA ST
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-2015
Mailing Address - Country:US
Mailing Address - Phone:864-517-4865
Mailing Address - Fax:
Practice Address - Street 1:691 S OAK ST
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-3827
Practice Address - Country:US
Practice Address - Phone:864-882-7563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional