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General NPI Number Information
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NPI Number | 1205992146
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Entity Type | Organization
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Legal Business Name | ROBERT L CLEMONS II
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 04/29/2013
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Provider Practice Location Address
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Address Line | 101 DEVANT ST SUITE 702
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-2710
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Country | US
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Telephone | 770-460-0970
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Fax | 866-758-5731
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Provider Business Mailing Address
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Address Line | 101 DEVANT ST SUITE 702
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-2710
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Country | US
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Telephone | 770-460-0970
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Fax | 866-758-5731
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Authorized Official
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Title or Position | CEO-CLINICAL DIRECTOR
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Name | MR. ROBERT L CLEMONS II
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Credential | LPC
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Telephone | 770-460-0970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 004041
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License Number State | GA
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