Individual
COLLEEN E CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC/C
Contact information
Practice address
901 WASHINGTON AVE STE 100, PORTLAND, ME 04103-2842
(207) 871-1200
(207) 871-1232
Mailing address
901 WASHINGTON AVE STE 100, PORTLAND, ME 04103-2842
(207) 871-1200
(207) 871-1232
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
XL5223
ME
Other
Enumeration date
06/25/2019
Last updated
06/25/2019
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