Provider Demographics
NPI:1750672606
Name:MCCAIN, LLC
Entity Type:Organization
Organization Name:MCCAIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCAIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,LPC,LLP,DOT-SAP
Authorized Official - Phone:313-952-1963
Mailing Address - Street 1:PO BOX 441381
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48244-1381
Mailing Address - Country:US
Mailing Address - Phone:313-952-1963
Mailing Address - Fax:313-331-9566
Practice Address - Street 1:2141 E JEFFERSON AVE
Practice Address - Street 2:SUITE LL 1
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4128
Practice Address - Country:US
Practice Address - Phone:313-952-1963
Practice Address - Fax:313-331-9566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008988174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty