Provider Demographics
NPI:1568110757
Name:CLIFFORD, RAYMOND CHARLES SR (BS, CSAC QMHP-A,C)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:CHARLES
Last Name:CLIFFORD
Suffix:SR
Gender:M
Credentials:BS, CSAC QMHP-A,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:140 LARKSPUR LN STE D
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2753
Mailing Address - Country:US
Mailing Address - Phone:276-236-6341
Mailing Address - Fax:276-236-6237
Practice Address - Street 1:140 LARKSPUR LN STE D
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2753
Practice Address - Country:US
Practice Address - Phone:276-236-6341
Practice Address - Fax:276-236-6237
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710103674101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)