Provider Demographics
NPI:1376762369
Name:CLAYBORN, ESOPHIA JOHNSON (LCSW PIP)
Entity Type:Individual
Prefix:
First Name:ESOPHIA
Middle Name:JOHNSON
Last Name:CLAYBORN
Suffix:
Gender:F
Credentials:LCSW PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 LONGWOOD DR SW
Mailing Address - Street 2:STE B
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5243
Mailing Address - Country:US
Mailing Address - Phone:256-536-9604
Mailing Address - Fax:
Practice Address - Street 1:201 LONGWOOD DR SW
Practice Address - Street 2:STE B
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5243
Practice Address - Country:US
Practice Address - Phone:256-536-9604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0807-2041C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical