Individual
NATHANIEL P CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCPC-C
Contact information
Practice address
11 BAXTER BLVD, PORTLAND, ME 04101-1801
(207) 774-8700
(207) 422-7268
Mailing address
11 BAXTER BLVD, PORTLAND, ME 04101-1801
(207) 774-8700
(207) 422-7268
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
XL4658
ME
101YP2500X
Professional Counselor
Primary
CC5420
ME
Other
Enumeration date
03/04/2016
Last updated
01/09/2024
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