Provider Demographics
NPI:1578734018
Name:CATHERINE CLODFELTER PHD PA
Entity Type:Organization
Organization Name:CATHERINE CLODFELTER PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:PROF
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLODFELTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:336-659-9440
Mailing Address - Street 1:PO BOX 24937
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27114-4937
Mailing Address - Country:US
Mailing Address - Phone:336-659-9440
Mailing Address - Fax:336-659-9845
Practice Address - Street 1:3000 BETHESDA PL STE 102
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3323
Practice Address - Country:US
Practice Address - Phone:336-965-9944
Practice Address - Fax:336-659-9845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1575103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0338NOtherBCBS
NC600336Medicaid
NC600336Medicaid