Provider Demographics
NPI:1881179000
Name:CLAYTON, EVETTE M (SERVICE FACILITATOR)
Entity type:Individual
Prefix:MISS
First Name:EVETTE
Middle Name:M
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:SERVICE FACILITATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3618 HUCKSTEP RD
Mailing Address - Street 2:
Mailing Address - City:BRODNAX
Mailing Address - State:VA
Mailing Address - Zip Code:23920-3029
Mailing Address - Country:US
Mailing Address - Phone:434-632-0937
Mailing Address - Fax:434-632-0937
Practice Address - Street 1:3618 HUCKSTEP RD
Practice Address - Street 2:
Practice Address - City:BRODNAX
Practice Address - State:VA
Practice Address - Zip Code:23920-3029
Practice Address - Country:US
Practice Address - Phone:434-632-0937
Practice Address - Fax:434-632-0937
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0257468725Medicaid