MEDICARE: AERIAL CLAY

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	1041C0700X	Clinical Social Worker	P018687	NC

General Provider Information

NPI Number	:	1972152452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AERIAL CLAY

Provider Business Mailing Address
First Line	:	8311 BRIER CREEK PKWY
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-7328
Country	:	US
Telephone Number	:	919-355-9050
Fax Number	:

Provider Business Practice Location Address
First Line	:	8311 BRIER CREEK PKWY
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-7328
Country	:	US
Telephone Number	:	919-355-9050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2019
Last Update Date	:	02/13/2023

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