Provider Demographics
NPI:1255433892
Name:CLODFELTER, CATHERINE JOY (PHD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:JOY
Last Name:CLODFELTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24937
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27114-4937
Mailing Address - Country:US
Mailing Address - Phone:336-794-0220
Mailing Address - Fax:336-794-1006
Practice Address - Street 1:3000 BETHESDA PL
Practice Address - Street 2:SUITE 102
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3331
Practice Address - Country:US
Practice Address - Phone:336-794-0220
Practice Address - Fax:336-794-1006
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1575103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000336Medicaid
NC6000336Medicaid
NCS09339Medicare UPIN