Provider Information for 1609448166
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Mrs. MELISSA T. CLEMMONS LCSW
Sex: Female
NPI: 1609448166
Last Updated: 2021-07-14
Certification Date: 2021-06-26
Certification Date: 2021-06-26
Details
| Name | Value | ||||||||
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| NPI | 1609448166 | ||||||||
| Enumeration Date | 2021-07-14 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 6217 ROCKY TRL ORLANDO, FL 32808-1469 United States Phone: 407-451-7304 | Fax:407-451-7304 | ||||||||
| Primary Practice Address | 6217 ROCKY TRL ORLANDO, FL 32808-1469 United States Phone: 407-451-7304 | Fax:407-296-8813 | ||||||||
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