Provider Demographics
NPI:1861136277
Name:MIDDLETON, CLARISSA JO (PHD, MED)
Entity type:Individual
Prefix:DR
First Name:CLARISSA
Middle Name:JO
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:PHD, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 PINNACLE WAY
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-6135
Mailing Address - Country:US
Mailing Address - Phone:863-329-2510
Mailing Address - Fax:
Practice Address - Street 1:4040 PINNACLE WAY
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815-6135
Practice Address - Country:US
Practice Address - Phone:863-329-2510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171000000XOther Service ProvidersMilitary Health Care Provider
No1744R1102XOther Service ProvidersSpecialistResearch Study
No251300000XAgenciesLocal Education Agency (LEA)
No251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No282J00000XHospitalsReligious Nonmedical Health Care Institution
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker