Provider Demographics
NPI:1952808909
Name:CLARKE, ERZULIE SIA NANDI (LPC)
Entity type:Individual
Prefix:
First Name:ERZULIE
Middle Name:SIA NANDI
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14685 CASSIANO RD
Mailing Address - Street 2:
Mailing Address - City:ELMENDORF
Mailing Address - State:TX
Mailing Address - Zip Code:78112-4707
Mailing Address - Country:US
Mailing Address - Phone:210-818-1560
Mailing Address - Fax:
Practice Address - Street 1:14685 CASSIANO RD
Practice Address - Street 2:
Practice Address - City:ELMENDORF
Practice Address - State:TX
Practice Address - Zip Code:78112-4707
Practice Address - Country:US
Practice Address - Phone:210-818-1560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74049101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional