Individual
DALICE D CLEMENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
601 S MARTIN LUTHER KING JR DR FL 432, WINSTON SALEM, NC 27110-8660
(336) 750-2000
Mailing address
121 BUSBEE VIEW RD, ASHEVILLE, NC 28803-8660
(828) 582-8011
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
225X00000X
Occupational Therapist
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000035689679
AETNA
NC
Enumeration date
03/23/2022
Last updated
03/26/2022
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