Provider Demographics
NPI:1679614937
Name:MCCLAIN, KERRI LEE (LPC)
Entity type:Individual
Prefix:MS
First Name:KERRI
Middle Name:LEE
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5320 COVINGTON CROSS DR
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-7755
Mailing Address - Country:US
Mailing Address - Phone:919-261-9512
Mailing Address - Fax:
Practice Address - Street 1:848 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-1706
Practice Address - Country:US
Practice Address - Phone:252-937-5493
Practice Address - Fax:252-937-5520
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3136101YP2500X
NC101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool