Provider Demographics
NPI:1417291253
Name:CLARKSON, MARY M (LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:CLARKSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 CULVERTON CT
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6122
Mailing Address - Country:US
Mailing Address - Phone:936-641-2700
Mailing Address - Fax:
Practice Address - Street 1:17163 BEAVER SPRINGS DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2345
Practice Address - Country:US
Practice Address - Phone:936-641-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-17
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009671101YM0800X
TX65321101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health