Individual
SAMANTHA K CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
113 ELM ST STE 204, ENFIELD, CT 06082-3739
(860) 741-3001
(086) 741-8332
Mailing address
34 WELCH AVE, WINDSOR, CT 06095-2935
(860) 741-3001
(860) 741-8332
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
002170
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004121141
—
CT
01
—
201366
MNH
CT
01
—
321137/A324839
VALUE OPTIONS
CT
01
—
4553929
AETNA
CT
01
—
A412956
OXFORD
CT
Enumeration date
04/13/2012
Last updated
04/13/2012
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