Provider Demographics
NPI:1407210099
Name:OWENS, CLIFFORD STEPHAN SR
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:STEPHAN
Last Name:OWENS
Suffix:SR
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 1:7 W BULLRUSH DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-3923
Mailing Address - Country:US
Mailing Address - Phone:336-997-0830
Mailing Address - Fax:
Practice Address - Street 1:7 W BULLRUSH DR
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-3923
Practice Address - Country:US
Practice Address - Phone:336-997-0830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2016602392101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor