Provider Demographics
NPI:1770631962
Name:CLINGHAM, DEANNA ROSEMARY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:ROSEMARY
Last Name:CLINGHAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:DEANNA
Other - Middle Name:ROSEMARY
Other - Last Name:SHUSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8956 WOODCREEK CIR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-8119
Mailing Address - Country:US
Mailing Address - Phone:910-686-5787
Mailing Address - Fax:910-686-5787
Practice Address - Street 1:8956 WOODCREEK CIR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-8119
Practice Address - Country:US
Practice Address - Phone:910-686-5787
Practice Address - Fax:910-686-5787
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5081101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5081OtherLPC
NJPC00082100OtherLPC