Provider Demographics
NPI:1952403214
Name:CLARKE, BARBARA A (LICENSED PSYCHOLOGIS)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:A
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LICENSED PSYCHOLOGIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 LOCUST FENCE ROAD
Mailing Address - Street 2:
Mailing Address - City:ST. HELENA ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29920
Mailing Address - Country:US
Mailing Address - Phone:843-541-0013
Mailing Address - Fax:
Practice Address - Street 1:2015 BOUNDARY ST.
Practice Address - Street 2:ONE BEAUFORT TOWN CENTER - EXECUTIVE SUITES #337
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902
Practice Address - Country:US
Practice Address - Phone:843-379-8696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT869103T00000X, 103TC0700X
SC103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT391755OtherMVP
VT1008394Medicaid
VT391755OtherMVP