Provider Demographics
NPI:1619673340
Name:CLINTON, KORTNEY (LCSW)
Entity Type:Individual
Prefix:
First Name:KORTNEY
Middle Name:
Last Name:CLINTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 332
Mailing Address - Street 2:
Mailing Address - City:LLOYD
Mailing Address - State:FL
Mailing Address - Zip Code:32337-0332
Mailing Address - Country:US
Mailing Address - Phone:850-296-2493
Mailing Address - Fax:
Practice Address - Street 1:87 LLOYD SUBDIVISION RD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344-8802
Practice Address - Country:US
Practice Address - Phone:850-296-2493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW210111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical