Provider Demographics
NPI:1194018069
Name:CLARK, ROSEMARY (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BELLEREVE DR
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-3134
Mailing Address - Country:US
Mailing Address - Phone:843-564-8275
Mailing Address - Fax:843-781-8909
Practice Address - Street 1:22 BELLEREVE DR
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29909-3134
Practice Address - Country:US
Practice Address - Phone:843-540-8368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006327101YP2500X
SCSC5583101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional