Provider Demographics
NPI:1316620271
Name:MCCLINE, LORI (LCADC)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:MCCLINE
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5105
Mailing Address - Country:US
Mailing Address - Phone:609-645-2500
Mailing Address - Fax:609-645-9467
Practice Address - Street 1:205 W PARKWAY DR
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5105
Practice Address - Country:US
Practice Address - Phone:609-645-2500
Practice Address - Fax:609-645-9467
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00232200101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)