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Organization
M L CLEMSON CORPORATION
Active
Organization
M L CLEMSON CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY LOUISE CLEMSON PSY CNS (PRESIDENT)
(757) 622-6673
Entity
Organization
Contact information
Practice address
602 MASSACHUSETTS AVE, NORFOLK, VA 23508-2118
(757) 622-6673
(757) 622-1086
Mailing address
602 MASSACHUSETTS AVE, NORFOLK, VA 23508-2118
(757) 622-6673
(757) 622-1086
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
0015000529
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101867
ANTHEM GROUP
VA
01
—
101868
ANTHEM
VA
01
—
1750563086
INDIVIDUAL NPI
VA
01
—
C08982
MEDICARE
VA
01
—
P00071810
RAILROAD
VA
Enumeration date
08/04/2006
Last updated
03/26/2008
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