Individual
DONALD R CLISE II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
7825 BALLANTYNE COMMONS PKWY, STE 110, CHARLOTTE, NC 28277-3174
(704) 446-0391
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
C008971
NC
104100000X
Social Worker
Primary
C008971
NC
1041C0700X
Clinical Social Worker
C008971
NC
Other
Enumeration date
09/15/2011
Last updated
07/15/2024
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