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NPI Code Detail

MEDICARE: LEAH CLARKE MS, NCC

MEDICARE: LEAH CLARKE MS, NCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1700095593
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEAH CLARKE MS, NCC
Provider Business Mailing Address
First Line : 5003 SCARLET HAW DR
Second Line :
City : GREENSBORO
State : NC
Zip : 27410-9604
Country : US
Telephone Number : 336-508-6593
Fax Number :
Provider Business Practice Location Address
First Line : 700 WALTER REED DR
Second Line :
City : GREENSBORO
State : NC
Zip : 27403-1128
Country : US
Telephone Number : 336-832-9600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2007
Last Update Date : 07/08/2007

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