Provider Demographics
NPI:1487377446
Name:CLARKE, DAVID ALAN (LCSW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALAN
Last Name:CLARKE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14104 N DEL WEBB TRL
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85658-5058
Mailing Address - Country:US
Mailing Address - Phone:206-724-9260
Mailing Address - Fax:
Practice Address - Street 1:14104 N DEL WEBB TRL
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85658-5058
Practice Address - Country:US
Practice Address - Phone:206-724-9260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-191091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical