Provider Demographics
NPI:1003371857
Name:CLEMENTS, ROBERT DEWANE II (LPC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DEWANE
Last Name:CLEMENTS
Suffix:II
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MARGATE DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-3351
Mailing Address - Country:US
Mailing Address - Phone:703-405-4140
Mailing Address - Fax:
Practice Address - Street 1:105 HEXHAM DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-3012
Practice Address - Country:US
Practice Address - Phone:434-237-2655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007923101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor