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General NPI Number Information
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NPI Number | 1972937407
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Entity Type | Individual
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Provider Name | DIANNE CLARKE NCC, LMHC, CAP, SAP
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Gender | Female
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Dates
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Enumeration Date | 09/03/2013
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Last Update Date | 03/20/2014
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Provider Practice Location Address
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Address Line | 778 SAINT ALBANS DR
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City | BOCA RATON
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State | FL
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Zip | 33486-1519
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Country | US
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Telephone | 561-445-8994
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Fax | 561-826-7005
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Provider Business Mailing Address
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Address Line | 778 SAINT ALBANS DR
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City | BOCA RATON
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State | FL
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Zip | 33486-1519
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Country | US
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Telephone | 561-445-8994
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Fax | 561-826-7005
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | MH 10994
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | MH 10994
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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 | MH 10994
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | MH 10994
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License Number State | FL
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