Provider Demographics
NPI:1275593568
Name:CLANCY, CAROLINA P (PHD)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:P
Last Name:CLANCY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 FULTON STREET (116E)
Mailing Address - Street 2:DURHAM VAMC
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705
Mailing Address - Country:US
Mailing Address - Phone:919-286-0411
Mailing Address - Fax:919-286-6812
Practice Address - Street 1:508 FULTON STREET (116E)
Practice Address - Street 2:DURHAM VAMC
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705
Practice Address - Country:US
Practice Address - Phone:919-286-0411
Practice Address - Fax:919-286-6812
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3105103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical