Provider Demographics
NPI:1760611206
Name:MCCLAIN, SALLIE B (LAC)
Entity Type:Individual
Prefix:MS
First Name:SALLIE
Middle Name:B
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:SALLIE
Other - Middle Name:B
Other - Last Name:RELIFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:428 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-0100
Mailing Address - Country:US
Mailing Address - Phone:478-296-9452
Mailing Address - Fax:478-296-9452
Practice Address - Street 1:1826 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-3620
Practice Address - Country:US
Practice Address - Phone:478-272-1210
Practice Address - Fax:478-274-5431
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1156101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)