Provider Demographics
NPI:1902233018
Name:CLARKE, WINSTON M (LICSW)
Entity Type:Individual
Prefix:MR
First Name:WINSTON
Middle Name:M
Last Name:CLARKE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5680 STEVENS FOREST RD
Mailing Address - Street 2:APT. 56
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-3371
Mailing Address - Country:US
Mailing Address - Phone:301-814-2816
Mailing Address - Fax:
Practice Address - Street 1:5680 STEVENS FOREST RD
Practice Address - Street 2:APT. 56
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3371
Practice Address - Country:US
Practice Address - Phone:301-814-2816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool