Provider Demographics
NPI:1699982124
Name:GERMOND, CLINTON MATTHEW (MS LPC LMHC NCC RPT)
Entity type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:MATTHEW
Last Name:GERMOND
Suffix:
Gender:M
Credentials:MS LPC LMHC NCC RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7460 CENTRAL BUSINESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-2818
Mailing Address - Country:US
Mailing Address - Phone:757-633-3201
Mailing Address - Fax:757-622-2011
Practice Address - Street 1:7460 CENTRAL BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-2818
Practice Address - Country:US
Practice Address - Phone:757-633-3201
Practice Address - Fax:757-622-2011
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004537101YM0800X
VA0701005879101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health