Individual
TERESA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, LADC
Contact information
Practice address
721 BATH RD, WISCASSET, ME 04578-4830
(207) 882-5300
Mailing address
721 BATH RD, WISCASSET, ME 04578-4830
(207) 882-5300
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LC3953
ME
1041C0700X
Clinical Social Worker
Primary
LC10536
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
82-2931653
TAX ID
ME
Enumeration date
05/10/2007
Last updated
04/13/2018
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