Provider Demographics
NPI:1205336617
Name:CLEMENT, KATRINA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:
Last Name:CLEMENT
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 1:31 STAFFORD AVE
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7246
Mailing Address - Country:US
Mailing Address - Phone:540-658-6000
Mailing Address - Fax:
Practice Address - Street 1:2135 MOUNTAIN VIEW RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-6411
Practice Address - Country:US
Practice Address - Phone:540-658-6840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040082351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical