Provider Demographics
NPI:1194328559
Name:ANYAMELE, CLINTON K
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:K
Last Name:ANYAMELE
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 1:7200 EDEN BROOK DR APT D202
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1459
Mailing Address - Country:US
Mailing Address - Phone:240-579-0807
Mailing Address - Fax:
Practice Address - Street 1:7200 EDEN BROOK DR APT D202
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1459
Practice Address - Country:US
Practice Address - Phone:240-579-0807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst