Provider Demographics
NPI:1497997167
Name:CLARKE, ED A (MASTERS THEOLOGY)
Entity Type:Individual
Prefix:MR
First Name:ED
Middle Name:A
Last Name:CLARKE
Suffix:
Gender:M
Credentials:MASTERS THEOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9925 INTERNATIONAL BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94603-2558
Mailing Address - Country:US
Mailing Address - Phone:510-562-3731
Mailing Address - Fax:510-562-3731
Practice Address - Street 1:9925 INTERNATIONAL BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94603-2558
Practice Address - Country:US
Practice Address - Phone:510-562-3731
Practice Address - Fax:510-562-3731
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral