Healthcare Provider Details

I. General information

NPI: 1710570528
Provider Name (Legal Business Name): MILLICENT CLARKSON LCSW-C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 W PENNSYLVANIA AVE STE 103
TOWSON MD
21204-4275
US

IV. Provider business mailing address

821 S BOULDIN ST
BALTIMORE MD
21224-4024
US

V. Phone/Fax

Practice location:
  • Phone: 443-353-9884
  • Fax:
Mailing address:
  • Phone: 410-967-6241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. MILLICENT CLARKSON
Title or Position: FOUNDER
Credential: LCSW-C
Phone: 443-353-9884