Provider Demographics
NPI:1689307316
Name:CLIFTON, CATHY RENEE'
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:RENEE'
Last Name:CLIFTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10427 BUTTRAM RD N
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:AL
Mailing Address - Zip Code:35988-2460
Mailing Address - Country:US
Mailing Address - Phone:256-996-5110
Mailing Address - Fax:
Practice Address - Street 1:772 MCCURDY AVE S
Practice Address - Street 2:
Practice Address - City:RAINSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35986-5211
Practice Address - Country:US
Practice Address - Phone:256-996-5110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-09
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3546A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health