Provider Demographics
NPI:1427648369
Name:REQUENA-LAYTON, CLARITA
Entity type:Individual
Prefix:
First Name:CLARITA
Middle Name:
Last Name:REQUENA-LAYTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 CHANDALAR DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-3541
Mailing Address - Country:US
Mailing Address - Phone:907-830-4050
Mailing Address - Fax:
Practice Address - Street 1:2221 E NORTHERN LIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4140
Practice Address - Country:US
Practice Address - Phone:907-865-6902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK212881101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional