Provider Demographics
NPI:1558863746
Name:CLARK, RICHELLE L (LPCMH, NCC)
Entity type:Individual
Prefix:
First Name:RICHELLE
Middle Name:L
Last Name:CLARK
Suffix:
Gender:F
Credentials:LPCMH, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:DE
Mailing Address - Zip Code:19940-1344
Mailing Address - Country:US
Mailing Address - Phone:302-841-1065
Mailing Address - Fax:
Practice Address - Street 1:10451 CONCORD RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-8651
Practice Address - Country:US
Practice Address - Phone:302-841-1065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-02
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000858101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health