Provider Demographics
NPI:1295403368
Name:CLANTON, MICHELLE RENEE (LCAS-A, MAC, BBA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENEE
Last Name:CLANTON
Suffix:
Gender:F
Credentials:LCAS-A, MAC, BBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-1156
Mailing Address - Country:US
Mailing Address - Phone:910-624-1771
Mailing Address - Fax:
Practice Address - Street 1:10508 PARK RD STE 130
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8526
Practice Address - Country:US
Practice Address - Phone:704-874-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)