Healthcare Provider Details

I. General information

NPI: 1578734018
Provider Name (Legal Business Name): CATHERINE CLODFELTER PHD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 BETHESDA PL STE 102
WINSTON SALEM NC
27103-3323
US

IV. Provider business mailing address

PO BOX 24937
WINSTON SALEM NC
27114-4937
US

V. Phone/Fax

Practice location:
  • Phone: 336-965-9944
  • Fax: 336-659-9845
Mailing address:
  • Phone: 336-659-9440
  • Fax: 336-659-9845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1575
License Number StateNC

VIII. Authorized Official

Name: PROF. CATHERINE CLODFELTER
Title or Position: OWNER
Credential: PHD
Phone: 336-659-9440