Provider Demographics
NPI:1417485673
Name:CLARKE, VIRGINIA KIM (LMSW)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:KIM
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 BROADWAY BLVD NE STE 401
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2366
Mailing Address - Country:US
Mailing Address - Phone:505-345-8471
Mailing Address - Fax:
Practice Address - Street 1:707 BROADWAY BLVD NE STE 401
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2366
Practice Address - Country:US
Practice Address - Phone:505-345-8471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health