Provider Demographics
NPI:1598093361
Name:CLARK, MONET L (LPCMH, CADC)
Entity Type:Individual
Prefix:MRS
First Name:MONET
Middle Name:L
Last Name:CLARK
Suffix:
Gender:F
Credentials:LPCMH, CADC
Other - Prefix:MS
Other - First Name:MONET
Other - Middle Name:L
Other - Last Name:DRUMMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4051 OGLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-3101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4051 OGLETOWN RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-3101
Practice Address - Country:US
Practice Address - Phone:302-290-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-05
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000475101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health