Provider Demographics
NPI:1861418584
Name:CLANTON-EDMONDS, BARBARA ANNE (LPC)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:ANNE
Last Name:CLANTON-EDMONDS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:ANNE
Other - Last Name:CLANTON-EDMONDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:60 NC HIGHWAY 125
Mailing Address - Street 2:TRIUMPH LLC
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-6304
Mailing Address - Country:US
Mailing Address - Phone:252-537-6619
Mailing Address - Fax:252-537-6786
Practice Address - Street 1:60 NC HIGHWAY 125
Practice Address - Street 2:TRIUMPH LLC
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-6304
Practice Address - Country:US
Practice Address - Phone:252-537-6619
Practice Address - Fax:252-537-6786
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA389101YA0400X
NC9234101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)