Provider Demographics
NPI:1801332648
Name:CLARK, CLAUDIA (LCPC)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 KAMPMAN CT
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9423
Mailing Address - Country:US
Mailing Address - Phone:410-207-8886
Mailing Address - Fax:
Practice Address - Street 1:3 KAMPMAN CT
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:MD
Practice Address - Zip Code:21152-9423
Practice Address - Country:US
Practice Address - Phone:410-207-8886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4810101YM0800X
MDLC11081101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health