Provider Demographics
NPI:1124012885
Name:CLARKE, PAULA SALGO (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:SALGO
Last Name:CLARKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 WIND CHIME CT
Mailing Address - Street 2:STE 204
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6477
Mailing Address - Country:US
Mailing Address - Phone:919-870-0063
Mailing Address - Fax:919-419-9257
Practice Address - Street 1:187 WIND CHIME CT
Practice Address - Street 2:STE 204
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6477
Practice Address - Country:US
Practice Address - Phone:919-870-0063
Practice Address - Fax:919-419-9257
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0832103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000597Medicaid
NC03360OtherBCBS
NCP00190910OtherRR MEDICARE
NC6000597Medicaid