Doctor Name: | CAROL CLENDINEN |
NPI Number: | 1063476265 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC, CAP, RN |
License Number: | CAP 311 |
Business Practice Address: | 115 E Citrus Ave Eustis, FL - 327264107 |
Business Phone Number: | 3523571500 |
Business Fax Number: | 3523606582 |
Mailing Address: | 35618 Calla Ct, LEESBURG |
State: | FL |
Postal Code: | 347882306 |
Phone Number: | 3523571500 |
Fax Number: | 3523606582 |
NPI Enumeration Date: | 04/14/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TA0400X |
License Number: | CAP 311 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |