Provider Demographics
NPI:1346887973
Name:CLAYTON, NICHOLAS TODD
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:TODD
Last Name:CLAYTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 SKYLARK DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-2930
Mailing Address - Country:US
Mailing Address - Phone:757-589-2356
Mailing Address - Fax:
Practice Address - Street 1:629 PHOENIX DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7392
Practice Address - Country:US
Practice Address - Phone:757-837-0761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAA67273036106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician