Provider Demographics
NPI:1134257256
Name:CLORE, MARIE PAYNE (EDS)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:PAYNE
Last Name:CLORE
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2553 WILDWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:AMISSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20106-2501
Mailing Address - Country:US
Mailing Address - Phone:540-229-8852
Mailing Address - Fax:504-937-7531
Practice Address - Street 1:897 HENDRICK ST
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-2201
Practice Address - Country:US
Practice Address - Phone:540-229-8852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0803000113103T00000X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool