Provider Demographics
NPI:1992892566
Name:MCLAIN, JOHN (LCSW)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MCLAIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 EUBANKS RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3623
Mailing Address - Country:US
Mailing Address - Phone:919-270-6525
Mailing Address - Fax:
Practice Address - Street 1:100 CAPITOLA DR STE 108
Practice Address - Street 2:ALEXANDRIA TECHNOLOGY CENTER
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-4496
Practice Address - Country:US
Practice Address - Phone:919-484-0601
Practice Address - Fax:919-484-0306
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0003381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002356Medicaid
NC60260OtherBCBS
NC2110776OtherMAMSI
NC6002385Medicaid
NCC000338OtherUBH
NC2119613OtherCIGNA
NCC000338OtherUNITED HEALTH CARE
NC131411OtherVALUE OPTIONS
NC258078OtherMHN
NC60260OtherHEALTHCHOICE
NC60260OtherMEDCOST
NC6272698OtherUBH