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NPI Code Detail

MEDICARE: ELIZABETH A. CLEMMONS L.P.C.

MEDICARE: ELIZABETH A. CLEMMONS L.P.C.
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
1101YP2500XProfessional Counselor0701002912VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17162588OTHERVAAETNA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3122559OTHERVAVALUE OPTIONS
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5O87894MOTHERVASOUTHERN HEALTH
6137455OTHERVAHEALTHKEEPERS
7137455OTHERVAANTHEM

General Provider Information

NPI Number : 1184686750
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH A. CLEMMONS L.P.C.
Provider Business Mailing Address
First Line : 9228 GEORGE WASHINGTON MEMORIAL HWY
Second Line :
City : GLOUCESTER
State : VA
Zip : 23061-4162
Country : US
Telephone Number : 804-693-5057
Fax Number : 804-693-7407
Provider Business Practice Location Address
First Line : 9228 GEORGE WASHINGTON MEMORIAL HWY
Second Line :
City : GLOUCESTER
State : VA
Zip : 23061-4162
Country : US
Telephone Number : 804-693-5057
Fax Number : 804-693-7407
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2006
Last Update Date : 07/09/2007

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