MEDICARE: DR. VAYLAH B CLINTON ED.D, LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LC4976	MD

General Provider Information

NPI Number	:	1134774243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VAYLAH B CLINTON ED.D, LCPC

Provider Business Mailing Address
First Line	:	9500 MEDICAL CENTER DR STE 106
Second Line	:
City	:	LARGO
State	:	MD
Zip	:	20774-3711
Country	:	US
Telephone Number	:	301-577-7307
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 MEDICAL CENTER DR STE 106
Second Line	:
City	:	LARGO
State	:	MD
Zip	:	20774-3711
Country	:	US
Telephone Number	:	301-577-7307
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2019
Last Update Date	:	08/06/2019

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