Provider Demographics
NPI:1720139934
Name:MCCLANAHAN, JOHN JOSEPH (PHD,CCDC,LCADC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:MCCLANAHAN
Suffix:
Gender:M
Credentials:PHD,CCDC,LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 BALTIMORE ANNAPOLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2455
Mailing Address - Country:US
Mailing Address - Phone:410-626-7550
Mailing Address - Fax:410-626-8805
Practice Address - Street 1:1454 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2455
Practice Address - Country:US
Practice Address - Phone:410-626-7550
Practice Address - Fax:410-626-8805
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA040101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)