Provider Demographics
NPI:1427460559
Name:HUTT-CLARKE, DONNA MELYNDA
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MELYNDA
Last Name:HUTT-CLARKE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MELYNDA
Other - Middle Name:
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NCC
Mailing Address - Street 1:15705 EASINGWOLD LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8021
Mailing Address - Country:US
Mailing Address - Phone:301-437-0365
Mailing Address - Fax:
Practice Address - Street 1:14418 OLD MILL RD STE 201
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3094
Practice Address - Country:US
Practice Address - Phone:240-326-7961
Practice Address - Fax:301-292-0275
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-23
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC-8800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0597617959-8OtherHEALTHCARE PROVIDERS INSURANCE (HPSO)