Doctor Name: | KIMBERLY CLARK |
NPI Number: | 1043506538 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC, NCC, MSED |
License Number: | CC3785 |
Business Practice Address: | 11 Port Dr Freeport, ME - 040326030 |
Business Phone Number: | 2078295099 |
Business Fax Number: | |
Mailing Address: | 11 Port Dr, FREEPORT |
State: | ME |
Postal Code: | 040326030 |
Phone Number: | 2078295099 |
Fax Number: | |
NPI Enumeration Date: | 06/22/2011 |
NPI Last Update Date: | 01/15/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | CC3785 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | ME |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |