Doctor Name: | ODELTA GUTIERREZ CLONTZ |
NPI Number: | 1033291091 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, LPC, NCC |
License Number: | 66026 |
Business Practice Address: | 2514 S Croatan Hwy Nags Head, NC - 279599016 |
Business Phone Number: | 2524494011 |
Business Fax Number: | 2524494050 |
Mailing Address: | 2514 S Croatan Hwy, NAGS HEAD |
State: | NC |
Postal Code: | 279599016 |
Phone Number: | 2524494011 |
Fax Number: | 2524494050 |
NPI Enumeration Date: | 10/19/2006 |
NPI Last Update Date: | 03/21/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 66026 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |