Individual
BROOKLYN PAIGE CLEMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LGSW
Contact information
Practice address
1215 STEWART PLZ, DUNBAR, WV 25064-3021
(304) 768-5506
Mailing address
1215 STEWART PLZ, DUNBAR, WV 25064-3021
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
BP00945239
WV
1041C0700X
Clinical Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810015614
—
WV
Enumeration date
12/03/2020
Last updated
12/03/2020
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