Provider Demographics
NPI:1578832416
Name:CLARKSON, DEANNA MICHELLE (BSW)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:MICHELLE
Last Name:CLARKSON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 45
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:WV
Mailing Address - Zip Code:26440-9707
Mailing Address - Country:US
Mailing Address - Phone:304-612-9090
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 45
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:WV
Practice Address - Zip Code:26440-9707
Practice Address - Country:US
Practice Address - Phone:304-612-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAP00938645171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator