Provider Demographics
NPI:1407220973
Name:CLEMONS, ELIZABETH CAROL
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CAROL
Last Name:CLEMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6516 ENFIELD MEWS
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3480
Mailing Address - Country:US
Mailing Address - Phone:443-987-6404
Mailing Address - Fax:443-914-2107
Practice Address - Street 1:6516 ENFIELD MEWS
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3480
Practice Address - Country:US
Practice Address - Phone:443-987-6404
Practice Address - Fax:443-914-2107
Is Sole Proprietor?:No
Enumeration Date:2015-11-21
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6643101YP2500X
AL3857101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
1407220973OtherELIZABETH CLEMONS MENTAL HEALTH COUNSELING SERVICES, LLC.
MD832327972OtherMENTAL HEALTH THERAPIST