Provider Demographics
NPI:1689838104
Name:CLARKE-BROWN, CANDACE MARIE (AT)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:MARIE
Last Name:CLARKE-BROWN
Suffix:
Gender:F
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-3362
Mailing Address - Country:US
Mailing Address - Phone:479-967-5570
Mailing Address - Fax:479-890-5364
Practice Address - Street 1:350 SALEM RD
Practice Address - Street 2:SUITE 1
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-7525
Practice Address - Country:US
Practice Address - Phone:501-336-8300
Practice Address - Fax:501-329-5508
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor