Provider Demographics
NPI:1295781599
Name:GARNER, KAREN YOLANDA CLEMMONS (LPC)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:YOLANDA CLEMMONS
Last Name:GARNER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:CLEMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:3333 SILAS CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3013
Mailing Address - Country:US
Mailing Address - Phone:336-718-3694
Mailing Address - Fax:336-718-9892
Practice Address - Street 1:3333 SILAS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3013
Practice Address - Country:US
Practice Address - Phone:336-718-3694
Practice Address - Fax:336-718-9892
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LGP194101YM0800X
MDLC2228101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD259147-000OtherMAGELLAN-ESPS GROUP#
MD609550004Medicaid
MD609550001Medicaid
MD522156095OtherNCPPO
MD517251OtherUHC-UBH-ESPS GROUP
MD892908-01OtherCAREFIRST BCBS PIN
MD986965400Medicaid
MD609550002Medicaid
MDLM49EAOtherCAREFIRST LOCAL-ESPS GROU
MD0034OtherCAREFIRST BCBS-FEDERAL
MD522156095OtherAMERICAN PSYCH SYSTEM
MDR968OtherCAREFIRST FEDERAL-ESPS GR
MDR968OtherCAREFIRST FEDERAL-ESPS GR
MD742LMedicare ID - Type UnspecifiedMEDICARE