Grace Taiyu Evadare Clements

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

510 Northgate Park Dr
Winston Salem, NC 27106-3486

Phone

(888) 446-7301

NPI assigned

Dec 19, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Carolina Counseling Wellness Associates

  • Community/Behavioral Health Agency
  • Cary, NC
  • NPI 1316310576
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1671408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671408000000",
    "number": "1942912266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 NORTHGATE PARK DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271063486",
            "telephone_number": "888-446-7301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 NORTHGATE PARK DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271063486",
            "telephone_number": "888-446-7301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMENTS",
        "first_name": "GRACE",
        "middle_name": "TAIYU EVADARE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-19",
        "last_updated": "2022-12-19",
        "certification_date": "2022-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "unknown",
            "affiliation": "N",
            "address_1": "510 Northgate Park Dr",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271063486",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Laurie Ann Cleary
• Jane Brethauer Cleland
• Dennis Mark Clemens, MD
• Caitlin Marie Clement, CRNA
• Dalice D Clement
• Clerico Optometry, P.a.
• John Clerico, O.D.
• Benicia Elaine Cleveland, MED, LAT, ATC
• Barbara Ann Clifford, MD
• Lucy M Clifford, MS, CCC-SLP

• Counselor in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.