Provider Demographics
NPI:1538559448
Name:MCCLURKIN, JOAN DUBOSE (MA MAC LPC LCMHC AAD)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:DUBOSE
Last Name:MCCLURKIN
Suffix:
Gender:F
Credentials:MA MAC LPC LCMHC AAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 PARK DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:SC
Mailing Address - Zip Code:29706-1952
Mailing Address - Country:US
Mailing Address - Phone:803-209-1545
Mailing Address - Fax:843-695-7931
Practice Address - Street 1:212 W MCGREGOR ST
Practice Address - Street 2:
Practice Address - City:PAGELAND
Practice Address - State:SC
Practice Address - Zip Code:29728-2137
Practice Address - Country:US
Practice Address - Phone:803-899-4973
Practice Address - Fax:843-695-7931
Is Sole Proprietor?:No
Enumeration Date:2015-01-30
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10831101YM0800X
NCA10831101YP2500X
SC6340101YP2500X
SC5751101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health