Healthcare Provider Details

I. General information

NPI: 1609796754
Provider Name (Legal Business Name): CLEM COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 S CHURCH ST
SOUTH CHARLESTON OH
45368-5013
US

IV. Provider business mailing address

PO BOX 584
SOUTH CHARLESTON OH
45368-0584
US

V. Phone/Fax

Practice location:
  • Phone: 937-539-0289
  • Fax:
Mailing address:
  • Phone: 937-539-0289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NICOLE CLEM
Title or Position: OWNER AND THERAPIST
Credential: LISW-S
Phone: 937-539-0289