Provider Demographics
NPI:1003149808
Name:CLARK, DARCIE RUPERT (MS, LPCC, LCDCIII)
Entity type:Individual
Prefix:MRS
First Name:DARCIE
Middle Name:RUPERT
Last Name:CLARK
Suffix:
Gender:F
Credentials:MS, LPCC, LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 W MONUMENT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-1293
Mailing Address - Country:US
Mailing Address - Phone:937-671-1589
Mailing Address - Fax:937-435-5865
Practice Address - Street 1:11 W MONUMENT AVE STE 100
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-1293
Practice Address - Country:US
Practice Address - Phone:937-679-6301
Practice Address - Fax:937-630-4391
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH991819101YA0400X
OHE08331-5101YA0400X
OHEO8331101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0184758Medicaid