1295781599 NPI number — MRS. KAREN YOLANDA CLEMMONS GARNER LPC

Table of content: MRS. KAREN YOLANDA CLEMMONS GARNER LPC (NPI 1295781599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295781599 NPI number — MRS. KAREN YOLANDA CLEMMONS GARNER LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARNER
Provider First Name:
KAREN
Provider Middle Name:
YOLANDA CLEMMONS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLEMMONS
Provider Other First Name:
KAREN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295781599
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3333 SILAS CREEK PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27103-3013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-718-3694
Provider Business Mailing Address Fax Number:
336-718-9892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3333 SILAS CREEK PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27103-3013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-718-3694
Provider Business Practice Location Address Fax Number:
336-718-9892
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LGP194 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: LC2228 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 259147-000 . This is a "MAGELLAN-ESPS GROUP#" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 609550004 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 609550001 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 522156095 . This is a "NCPPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 517251 . This is a "UHC-UBH-ESPS GROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 892908-01 . This is a "CAREFIRST BCBS PIN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 986965400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 609550002 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: LM49EA . This is a "CAREFIRST LOCAL-ESPS GROU" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0034 . This is a "CAREFIRST BCBS-FEDERAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 522156095 . This is a "AMERICAN PSYCH SYSTEM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: R968 . This is a "CAREFIRST FEDERAL-ESPS GR" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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