Individual
JONATHAN BLAKE CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCAS
Contact information
Practice address
1529 SHEPARD RD SE, SOUTHPORT, NC 28461-9435
(704) 249-4231
(828) 544-1201
Mailing address
1529 SHEPARD RD SE, SOUTHPORT, NC 28461-9435
(704) 249-4231
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCAS-2729
NC
Other
Enumeration date
10/05/2015
Last updated
12/06/2023
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