Healthcare Provider Details

I. General information

NPI: 1285561498
Provider Name (Legal Business Name): JAIME LYNN CLIFTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 LINSTEAD DR
INDIAN TRAIL NC
28079-3668
US

IV. Provider business mailing address

2012 LINSTEAD DR
INDIAN TRAIL NC
28079-3668
US

V. Phone/Fax

Practice location:
  • Phone: 850-529-4810
  • Fax:
Mailing address:
  • Phone: 850-529-4810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP023555
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: