Provider Demographics
NPI:1346531365
Name:CLEMONS, STEVEN LLOYD JR (MAMFC, LCMHC, LMFT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:LLOYD
Last Name:CLEMONS
Suffix:JR
Gender:M
Credentials:MAMFC, LCMHC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 CARMEL EXECUTIVE PARK DR
Mailing Address - Street 2:#210
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-8275
Mailing Address - Country:US
Mailing Address - Phone:704-752-8414
Mailing Address - Fax:704-544-1109
Practice Address - Street 1:7401 CARMEL EXECUTIVE PARK DR
Practice Address - Street 2:#210
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8275
Practice Address - Country:US
Practice Address - Phone:704-752-8414
Practice Address - Fax:704-544-1109
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8284101YP2500X
NC1463106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105348Medicaid