Provider Demographics
NPI:1093434573
Name:CLODFELTER, KERRY MICHELLE (LCMHCA)
Entity Type:Individual
Prefix:MS
First Name:KERRY
Middle Name:MICHELLE
Last Name:CLODFELTER
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SAINT ALBANS DR APT 209
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5813
Mailing Address - Country:US
Mailing Address - Phone:336-688-6501
Mailing Address - Fax:
Practice Address - Street 1:120 SAINT ALBANS DR APT 209
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5813
Practice Address - Country:US
Practice Address - Phone:336-688-6501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17565101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health