Provider Demographics
NPI:1679307334
Name:MCCLAIN, DARIUS JEVELLE (LMFTA)
Entity type:Individual
Prefix:
First Name:DARIUS
Middle Name:JEVELLE
Last Name:MCCLAIN
Suffix:
Gender:M
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9517 NEWELL HICKORY GROVE RD UNIT 6
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-1983
Mailing Address - Country:US
Mailing Address - Phone:980-267-1779
Mailing Address - Fax:
Practice Address - Street 1:9541 JULIAN CLARK AVE STE 208
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-3486
Practice Address - Country:US
Practice Address - Phone:980-297-8237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20037A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist