Healthcare Provider Details

I. General information

NPI: 1699353490
Provider Name (Legal Business Name): CLIFTON DALE GARNER SR. PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8450 FALLS OF NEUSE RD STE 200
RALEIGH NC
27615-3549
US

IV. Provider business mailing address

1502 W NC HIGHWAY 54 STE 403
DURHAM NC
27707-5599
US

V. Phone/Fax

Practice location:
  • Phone: 919-418-1718
  • Fax: 919-794-5715
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberA16384
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA16384
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: