Provider Demographics
NPI:1568681617
Name:DUPRE-CLARK, ALAN (D MIN, LPCC, AAMFT)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:DUPRE-CLARK
Suffix:
Gender:M
Credentials:D MIN, LPCC, AAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4480 REFUGEE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4459
Mailing Address - Country:US
Mailing Address - Phone:614-751-9112
Mailing Address - Fax:614-751-9116
Practice Address - Street 1:4480 REFUGEE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4459
Practice Address - Country:US
Practice Address - Phone:614-751-9112
Practice Address - Fax:614-751-9116
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0000464101YP2500X
OHF029106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist