Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 991819 | OH |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | E08331-5 | OH |
Y | 101YM0800X | Mental Health Counselor | EO8331 | OH |
N | 101YP2500X | Professional Counselor | EO8331 | OH |
NPI | 1003149808 |
---|---|
Provider Name | Mrs. Darcie Rupert Clark |
First Address | Dayton, OH 45402-1293 |
Second Address | Dayton, OH 45402-1293 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2009 |
Last Update Date | 28/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0184758 | (05) | OH |