Healthcare Provider Details

I. General information

NPI: 1093450462
Provider Name (Legal Business Name): MAUDELINE CLERVOIX-FRANK LCMHCA, LCASA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2022
Last Update Date: 10/23/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8620 ENGLISH SADDLE DR
FAYETTEVILLE NC
28314-6069
US

IV. Provider business mailing address

8620 ENGLISH SADDLE DR
FAYETTEVILLE NC
28314-6069
US

V. Phone/Fax

Practice location:
  • Phone: 929-270-2137
  • Fax: 910-824-7593
Mailing address:
  • Phone: 929-270-2137
  • Fax: 910-824-7593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA18506
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-28787
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: