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General NPI Number Information
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NPI Number | 1285124776
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Entity Type | Individual
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Provider Name | KENUATED L CLARKE LMHC
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Gender | Female
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Dates
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Enumeration Date | 05/10/2018
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Last Update Date | 05/10/2018
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Provider Practice Location Address
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Address Line | 602 MELTON AVE
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City | AUBURNDALE
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State | FL
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Zip | 33823-4428
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Country | US
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Telephone | 863-967-8190
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Fax | 863-967-8192
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Provider Business Mailing Address
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Address Line | 536 MAJESTIC GARDENS BLVD
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City | WINTER HAVEN
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State | FL
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Zip | 33880-5736
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Country | US
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Telephone | 863-677-4029
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 13722
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License Number State | FL
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