Provider Demographics
NPI:1326099706
Name:CLARK, HELEN YOLANDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:HELEN
Middle Name:YOLANDA
Last Name:CLARK
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 1:223 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3726
Mailing Address - Country:US
Mailing Address - Phone:843-761-5707
Mailing Address - Fax:843-899-2184
Practice Address - Street 1:223 1ST ST
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3726
Practice Address - Country:US
Practice Address - Phone:843-761-5707
Practice Address - Fax:843-899-2184
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC410155101YA0400X
SC606101YM0800X
SC22121041C0700X
SC193106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQM0260Medicaid
SCQM0260Medicaid