Healthcare Provider Details

I. General information

NPI: 1801332812
Provider Name (Legal Business Name): CLARK COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MECHANIC ST STE 200
WINDSOR CT
06095-2545
US

IV. Provider business mailing address

41 MECHANIC ST STE 200
WINDSOR CT
06095-2545
US

V. Phone/Fax

Practice location:
  • Phone: 860-920-4420
  • Fax:
Mailing address:
  • Phone: 860-920-4420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW CLARK
Title or Position: CEO
Credential:
Phone: 860-920-4418