Provider Demographics
NPI:1154822328
Name:CLARK, SHERYL ANNE (LPC-A, LCAS-A)
Entity Type:Individual
Prefix:MS
First Name:SHERYL
Middle Name:ANNE
Last Name:CLARK
Suffix:
Gender:F
Credentials:LPC-A, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12740 SPRUCE TREE WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8295
Mailing Address - Country:US
Mailing Address - Phone:919-916-1160
Mailing Address - Fax:919-488-4226
Practice Address - Street 1:12740 SPRUCE TREE WAY STE 102
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8295
Practice Address - Country:US
Practice Address - Phone:919-916-1160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NCA21708101YA0400X
NCA12269101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)