Healthcare Provider Details

I. General information

NPI: 1326099706
Provider Name (Legal Business Name): HELEN YOLANDA CLARK PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 1ST ST
MONCKS CORNER SC
29461-3726
US

IV. Provider business mailing address

223 1ST ST
MONCKS CORNER SC
29461-3726
US

V. Phone/Fax

Practice location:
  • Phone: 843-761-5707
  • Fax: 843-899-2184
Mailing address:
  • Phone: 843-761-5707
  • Fax: 843-899-2184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number410155
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number606
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2212
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number193
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: