Healthcare Provider Details

I. General information

NPI: 1346934213
Provider Name (Legal Business Name): CAROLINE CLARKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAROLINE PARKER

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 BROOK RD STE B
RICHMOND VA
23220-1801
US

IV. Provider business mailing address

1605 BROOK RD
RICHMOND VA
23220-1801
US

V. Phone/Fax

Practice location:
  • Phone: 804-644-4444
  • Fax:
Mailing address:
  • Phone: 804-644-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0906013759
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: