Provider Demographics
NPI:1396006839
Name:CLEMENTS-SHANDS, CARLA MARIE (MS, LADACII)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:MARIE
Last Name:CLEMENTS-SHANDS
Suffix:
Gender:F
Credentials:MS, LADACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 DERRY PARK DRIVE #9
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-1937
Mailing Address - Country:US
Mailing Address - Phone:561-400-4591
Mailing Address - Fax:
Practice Address - Street 1:3 DERRY PARK DRIVE #9
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-1937
Practice Address - Country:US
Practice Address - Phone:561-400-4591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA840101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)