MEDICARE: THE CLARITY LOFT, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1528707833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CLARITY LOFT, PLLC

Provider Business Mailing Address
First Line	:	2112 REDGATE DR
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-1003
Country	:	US
Telephone Number	:	757-529-3189
Fax Number	:

Provider Business Practice Location Address
First Line	:	1910 PACIFIC AVE STE 6070
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-4532
Country	:	US
Telephone Number	:	757-529-3189
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BENITA L THORNHILL
Credential	:
Telephone Number	:	757-529-3189

Provider Enumeration Date	:	06/03/2022
Last Update Date	:	07/05/2022

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