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NPI Code Detail

MEDICARE: CAROL CLAY PSY.D.

MEDICARE: CAROL CLAY PSY.D.
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
1103TC0700XClinical Psychologist0810007698VA

General Provider Information

NPI Number : 1205318078
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROL CLAY PSY.D.
Provider Business Mailing Address
First Line : 26317 W. WASHINGTON STREET
Second Line : PO BOX 4030
City : PETERSBURG
State : VA
Zip : 23803-2727
Country : US
Telephone Number : 804-524-4445
Fax Number :
Provider Business Practice Location Address
First Line : 26317 WASHINGTON ST
Second Line :
City : NORTH DINWIDDIE
State : VA
Zip : 23803-2727
Country : US
Telephone Number : 804-524-4445
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2018
Last Update Date : 09/12/2022

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