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General NPI Number Information
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NPI Number | 1861136277
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Entity Type | Individual
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Provider Name | CLARISSA JO MIDDLETON P.H.D., M.ED.
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Gender | Female
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Dates
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Enumeration Date | 04/21/2022
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Last Update Date | 04/21/2022
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Provider Practice Location Address
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Address Line | 4040 PINNACLE WAY
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City | HEPHZIBAH
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State | GA
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Zip | 30815-6135
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Country | US
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Telephone | 863-329-2510
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Fax |
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Provider Business Mailing Address
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Address Line | 4040 PINNACLE WAY
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City | HEPHZIBAH
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State | GA
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Zip | 30815-6135
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Country | US
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Telephone | 863-329-2510
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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Taxonomy #3
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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Taxonomy #4
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Taxonomy Code | 1744R1102X
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Taxonomy Name | Research Study Specialist
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Taxonomy #5
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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Taxonomy #6
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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Taxonomy #7
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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Taxonomy #8
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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Taxonomy #9
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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Taxonomy #10
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Taxonomy Code | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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Taxonomy #11
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Taxonomy Code | 282J00000X
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Taxonomy Name | Religious Nonmedical Health Care Institution
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Taxonomy #12
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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Taxonomy #13
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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Taxonomy #14
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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