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General NPI Number Information
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NPI Number | 1295549079
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Entity Type | Individual
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Provider Name | MICHAEL D CLARKE ADT
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Gender | Male
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 1401 MADISON PARK DR STE 100A
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City | GLEN BURNIE
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State | MD
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Zip | 21061-6140
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Country | US
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Telephone | 410-999-0891
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Fax |
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Provider Business Mailing Address
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Address Line | 7610 FAIRBANKS CT
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City | HANOVER
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State | MD
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Zip | 21076-1638
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Country | US
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Telephone | 443-340-4803
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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 | ADT3733
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License Number State | MD
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