Provider Demographics
NPI:1871101436
Name:CLARK, DELZORA MAE (MA, LCMHC, NCC)
Entity type:Individual
Prefix:
First Name:DELZORA
Middle Name:MAE
Last Name:CLARK
Suffix:
Gender:F
Credentials:MA, LCMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 S GLENBURNIE RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5261
Mailing Address - Country:US
Mailing Address - Phone:252-349-9672
Mailing Address - Fax:888-649-2167
Practice Address - Street 1:2002 S GLENBURNIE RD STE 4D
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5230
Practice Address - Country:US
Practice Address - Phone:252-515-0896
Practice Address - Fax:888-649-2167
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC313010101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor