Provider Demographics
NPI:1750047262
Name:CLAY, DEMETRIUS (LPC, EDS, MS)
Entity Type:Individual
Prefix:
First Name:DEMETRIUS
Middle Name:
Last Name:CLAY
Suffix:
Gender:M
Credentials:LPC, EDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 SWEET GUM BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-8024
Mailing Address - Country:US
Mailing Address - Phone:601-816-8375
Mailing Address - Fax:
Practice Address - Street 1:527 SWEET GUM BOTTOM RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-8024
Practice Address - Country:US
Practice Address - Phone:601-816-8375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2713101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health