Healthcare Provider Details

I. General information

NPI: 1154955722
Provider Name (Legal Business Name): ARIANE NICOLE CLANCY LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2020
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

996 HELEN ST
FAYETTEVILLE NC
28303-3069
US

IV. Provider business mailing address

996 HELEN ST
FAYETTEVILLE NC
28303-3069
US

V. Phone/Fax

Practice location:
  • Phone: 910-860-7008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA15535
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: