Provider Demographics
NPI:1083960827
Name:CLARK, LINDA M (MA, LPPC-S)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:M
Last Name:CLARK
Suffix:
Gender:F
Credentials:MA, LPPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 844020
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4020
Mailing Address - Country:US
Mailing Address - Phone:216-450-1613
Mailing Address - Fax:
Practice Address - Street 1:4510 DRESSLER RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2546
Practice Address - Country:US
Practice Address - Phone:216-450-1613
Practice Address - Fax:216-450-1614
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1100179101YP2500X
OHE.1100179-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional