Provider Demographics
NPI:1679659130
Name:CLAYTON, CHERYL A (LCSW)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 352
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24212-0352
Mailing Address - Country:US
Mailing Address - Phone:276-254-5445
Mailing Address - Fax:276-206-8045
Practice Address - Street 1:205 W MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2765
Practice Address - Country:US
Practice Address - Phone:276-254-5445
Practice Address - Fax:276-206-8045
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904003155101YA0400X, 1041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008927154Medicaid
VA008927154Medicaid