Provider Demographics
NPI:1194310987
Name:CLAY, ROBERT CHARLES
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHARLES
Last Name:CLAY
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 1:2003 BAYVIEW HEIGHTS DR SPC 123
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-5537
Mailing Address - Country:US
Mailing Address - Phone:619-214-7187
Mailing Address - Fax:
Practice Address - Street 1:550 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-1643
Practice Address - Country:US
Practice Address - Phone:760-489-6380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)