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General NPI Number Information
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NPI Number | 1578734018
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Entity Type | Organization
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Legal Business Name | CATHERINE CLODFELTER PHD PA
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Dates
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Enumeration Date | 03/12/2008
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Last Update Date | 09/02/2010
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Provider Practice Location Address
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Address Line | 3000 BETHESDA PL STE 102
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City | WINSTON SALEM
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State | NC
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Zip | 27103-3323
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Country | US
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Telephone | 336-965-9944
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Fax | 336-659-9845
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Provider Business Mailing Address
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Address Line | PO BOX 24937
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City | WINSTON SALEM
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State | NC
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Zip | 27114-4937
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Country | US
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Telephone | 336-659-9440
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Fax | 336-659-9845
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Authorized Official
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Title or Position | OWNER
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Name | PROF. CATHERINE CLODFELTER
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Credential | PHD
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Telephone | 336-659-9440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1575
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License Number State | NC
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