Healthcare Provider Details

I. General information

NPI: 1205318078
Provider Name (Legal Business Name): CAROL CLAY PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26317 WASHINGTON ST
NORTH DINWIDDIE VA
23803-2727
US

IV. Provider business mailing address

26317 W. WASHINGTON STREET PO BOX 4030
PETERSBURG VA
23803-2727
US

V. Phone/Fax

Practice location:
  • Phone: 804-524-4445
  • Fax:
Mailing address:
  • Phone: 804-524-4445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810007698
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: