Provider Demographics
NPI:1053986489
Name:CLEMENTS, MACEY
Entity type:Individual
Prefix:
First Name:MACEY
Middle Name:
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 CHARTER DR STE B
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3587
Mailing Address - Country:US
Mailing Address - Phone:810-877-6343
Mailing Address - Fax:810-674-0044
Practice Address - Street 1:1170 CHARTER DR STE B
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3587
Practice Address - Country:US
Practice Address - Phone:810-877-6343
Practice Address - Fax:810-674-0044
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011099031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical