Individual
MR. MARILYN RUTH MCCLURE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
11315 PEMBROOKE MEDICAL CENTER, SUITE 112-A, WALDORF, MD 20602
(301) 645-2233
(301) 645-3633
Mailing address
1009 NORFOLK DR, LA PLATA, MD 20646-3551
(301) 645-2233
(301) 645-3633
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LC0866
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260971
COMPSYCH
MD
01
—
298AS0
BLUECROSS BLUE SHIELD MD
MH
01
—
333071
MHN
MD
01
—
4125532
MAMSI
MH
01
—
413463
VALUE OPTIONS
MD
01
—
7290615
AETNA
MD
01
—
J340 0001
BLUE CROSS BLUE SHIELD
MD
Enumeration date
08/04/2006
Last updated
07/09/2007
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