Provider Demographics
NPI:1578682076
Name:CLANTON, KAREN (LPC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:CLANTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 PEACHTREE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-2758
Mailing Address - Country:US
Mailing Address - Phone:704-392-7995
Mailing Address - Fax:704-332-4557
Practice Address - Street 1:1123 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4003
Practice Address - Country:US
Practice Address - Phone:704-370-3235
Practice Address - Fax:704-370-3377
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC 4626101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC141M3OtherBLUECROSS BLUESHIELD
NC6102936Medicaid