Provider Demographics
NPI:1992836258
Name:CLARKE, JAMES B SR (MA LPC NCC BLSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:B
Last Name:CLARKE
Suffix:SR
Gender:M
Credentials:MA LPC NCC BLSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 SEMINOLE DR
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286
Mailing Address - Country:US
Mailing Address - Phone:517-902-3136
Mailing Address - Fax:
Practice Address - Street 1:604 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-3215
Practice Address - Country:US
Practice Address - Phone:517-902-3136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional