Provider Demographics
NPI:1033398987
Name:CLARKE, TAWANDA (MA, LPC, CAADC)
Entity Type:Individual
Prefix:
First Name:TAWANDA
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MA, LPC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 SOUTHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-2753
Mailing Address - Country:US
Mailing Address - Phone:269-808-6556
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:609 SOUTHLAND AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-2753
Practice Address - Country:US
Practice Address - Phone:269-808-6556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor