Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 0701007923 | VA |
NPI | 1003371857 |
---|---|
Provider Name | Mr. Robert Dewane Clements II |
First Address | Lynchburg, VA 24502-3351 |
Second Address | Lynchburg, VA 24502-3012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2019 |
Last Update Date | 06/02/2019 |