Provider Demographics
NPI:1063476265
Name:CLENDINEN, CAROL (LMHC, CAP, RN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:CLENDINEN
Suffix:
Gender:F
Credentials:LMHC, CAP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35618 CALLA CT
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-2306
Mailing Address - Country:US
Mailing Address - Phone:352-357-1500
Mailing Address - Fax:352-360-6582
Practice Address - Street 1:115 E CITRUS AVE
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-4107
Practice Address - Country:US
Practice Address - Phone:352-357-1500
Practice Address - Fax:352-360-6582
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP 311103TA0400X
FLMH 2625103TC0700X
FLRN 793372163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ090QOtherBLUE CROSS BLUE SHIELD #