Provider Demographics
NPI:1679279392
Name:CLAYBURN, ERIC GAITHER
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:GAITHER
Last Name:CLAYBURN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SIMONE WAY
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-7750
Mailing Address - Country:US
Mailing Address - Phone:386-846-5412
Mailing Address - Fax:904-669-1847
Practice Address - Street 1:201 SIMONE WAY
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-7750
Practice Address - Country:US
Practice Address - Phone:386-846-5412
Practice Address - Fax:904-669-1847
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW225471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical