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NPI Code Detail

MEDICARE: MR. CLINTON MATTHEW GERMOND MS LPC LMHC NCC RPT

MEDICARE: MR. CLINTON MATTHEW GERMOND MS LPC LMHC NCC RPT
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
1101YM0800XMental Health Counselor004537NY
2101YP2500XProfessional Counselor0701005879VA

General Provider Information

NPI Number : 1699982124
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CLINTON MATTHEW GERMOND MS LPC LMHC NCC RPT
Provider Business Mailing Address
First Line : 7460 CENTRAL BUSINESS PARK DR
Second Line :
City : NORFOLK
State : VA
Zip : 23513-2818
Country : US
Telephone Number : 757-633-3201
Fax Number : 757-622-2011
Provider Business Practice Location Address
First Line : 7460 CENTRAL BUSINESS PARK DR
Second Line :
City : NORFOLK
State : VA
Zip : 23513-2818
Country : US
Telephone Number : 757-633-3201
Fax Number : 757-622-2011
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2007
Last Update Date : 11/11/2014

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