Provider Demographics
NPI:1730551391
Name:CLEMMONS, NICHOLAS ALAN (LAC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ALAN
Last Name:CLEMMONS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-5329
Mailing Address - Country:US
Mailing Address - Phone:501-777-5969
Mailing Address - Fax:
Practice Address - Street 1:513 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-5329
Practice Address - Country:US
Practice Address - Phone:501-777-5969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health