Provider Demographics
NPI:1669806840
Name:CLARK, DARSHA DARLENE (LPC)
Entity type:Individual
Prefix:
First Name:DARSHA
Middle Name:DARLENE
Last Name:CLARK
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 RAINBOW WAY UNIT 115
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-3994
Mailing Address - Country:US
Mailing Address - Phone:678-235-5120
Mailing Address - Fax:470-264-7142
Practice Address - Street 1:154 RAINBOW WAY UNIT 115
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-3994
Practice Address - Country:US
Practice Address - Phone:678-235-5120
Practice Address - Fax:470-264-7142
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-24
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007363101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health