Healthcare Provider Details

I. General information

NPI: 1912196213
Provider Name (Legal Business Name): DORIS CLEMENTS CPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W PRATT ST
BALTIMORE MD
21201-1023
US

IV. Provider business mailing address

PO BOX 64515
BALTIMORE MD
21264-4515
US

V. Phone/Fax

Practice location:
  • Phone: 717-428-0552
  • Fax: 717-428-0518
Mailing address:
  • Phone: 717-428-0552
  • Fax: 717-428-0518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAC0253
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: