Provider Demographics
NPI:1871600064
Name:CLARK, SHERI A (LCPC)
Entity type:Individual
Prefix:MRS
First Name:SHERI
Middle Name:A
Last Name:CLARK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BARDWELL ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-6335
Mailing Address - Country:US
Mailing Address - Phone:207-786-3556
Mailing Address - Fax:207-786-3559
Practice Address - Street 1:35 BARDWELL ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6335
Practice Address - Country:US
Practice Address - Phone:207-786-3556
Practice Address - Fax:207-786-3559
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1128101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional