Provider Demographics
NPI:1760888648
Name:PAUL, CLYDE HAROLD III
Entity Type:Individual
Prefix:
First Name:CLYDE
Middle Name:HAROLD
Last Name:PAUL
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1157 TWISTING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-9818
Mailing Address - Country:US
Mailing Address - Phone:252-484-3871
Mailing Address - Fax:
Practice Address - Street 1:313 CLIFTON ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5008
Practice Address - Country:US
Practice Address - Phone:252-353-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10589101YP2500X
NC10589101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional