Healthcare Provider Details

I. General information

NPI: 1013616382
Provider Name (Legal Business Name): ROBIN E CLARKE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 04/05/2026
Certification Date: 04/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 CARDENAS DR NE
ALBUQUERQUE NM
87108-1720
US

IV. Provider business mailing address

145 LAKESIDE DR
LEWISBERRY PA
17339-9235
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-8168
  • Fax:
Mailing address:
  • Phone: 720-202-9642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2023-0981
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: