Provider Demographics
NPI:1982044301
Name:CLARKE, NETTIE ROSE (MS, CRC, LPC LCAS)
Entity Type:Individual
Prefix:MRS
First Name:NETTIE
Middle Name:ROSE
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MS, CRC, LPC LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 N ELM ST STE D2
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-5100
Mailing Address - Country:US
Mailing Address - Phone:336-383-9932
Mailing Address - Fax:336-285-7868
Practice Address - Street 1:2102 N ELM ST STE D2
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-5100
Practice Address - Country:US
Practice Address - Phone:336-383-9932
Practice Address - Fax:336-285-7868
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-29
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCASA20041101YA0400X
NC10171101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health