Provider Demographics
NPI:1104680560
Name:CLEMENTS, AARON GREGORY (CDCA PRELIMINARY)
Entity type:Individual
Prefix:MR
First Name:AARON
Middle Name:GREGORY
Last Name:CLEMENTS
Suffix:
Gender:M
Credentials:CDCA PRELIMINARY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 E 2ND ST UNIT 1043
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45403-1020
Mailing Address - Country:US
Mailing Address - Phone:937-240-2600
Mailing Address - Fax:
Practice Address - Street 1:215 MCDANIEL ST APT 205
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-4823
Practice Address - Country:US
Practice Address - Phone:937-529-9795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.187262101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)