Provider Demographics
NPI:1093053811
Name:CLARKE, ALICIA MAY (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:MAY
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 HOLLYHOCK RD
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8642
Mailing Address - Country:US
Mailing Address - Phone:561-267-3904
Mailing Address - Fax:561-793-6116
Practice Address - Street 1:16401 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9236
Practice Address - Country:US
Practice Address - Phone:561-267-3904
Practice Address - Fax:561-791-0408
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11576101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health