Provider Demographics
NPI:1710570528
Name:MILLICENT CLARKSON LCSW-C
Entity Type:Organization
Organization Name:MILLICENT CLARKSON LCSW-C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:MILLICENT
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-353-9884
Mailing Address - Street 1:821 S BOULDIN ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4024
Mailing Address - Country:US
Mailing Address - Phone:410-967-6241
Mailing Address - Fax:
Practice Address - Street 1:406 W PENNSYLVANIA AVE STE 103
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-4275
Practice Address - Country:US
Practice Address - Phone:443-353-9884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty