Provider Demographics
NPI:1578052460
Name:CLENDENIN, AARON (MCAP)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:CLENDENIN
Suffix:
Gender:M
Credentials:MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 FERN AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6029
Mailing Address - Country:US
Mailing Address - Phone:407-341-8979
Mailing Address - Fax:
Practice Address - Street 1:930 FERN AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814-6029
Practice Address - Country:US
Practice Address - Phone:407-341-8979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL100420101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)