Provider Demographics
NPI:1649655002
Name:CLEMENTS, CHRISTINA CAROL (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:CAROL
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 BRASWELL LN LOT 3
Mailing Address - Street 2:
Mailing Address - City:SIMSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71275-3266
Mailing Address - Country:US
Mailing Address - Phone:318-243-4202
Mailing Address - Fax:
Practice Address - Street 1:1416 NATCHITOCHES ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292-3751
Practice Address - Country:US
Practice Address - Phone:318-855-8773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4336101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health