=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093450462
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAUDELINE CLERVOIX-FRANK LCMHCA, LCASA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2022
-----------------------------------------------------
Last Update Date | 10/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8620 ENGLISH SADDLE DR
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28314-6069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-270-2137
-----------------------------------------------------
Fax | 910-824-7593
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8620 ENGLISH SADDLE DR
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28314-6069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-270-2137
-----------------------------------------------------
Fax | 910-824-7593
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | A18506
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | LCAS-28787
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------