Provider Demographics
NPI:1427529841
Name:CLARK, KIMBERLY S (LCDP, LMSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:CLARK
Suffix:
Gender:F
Credentials:LCDP, LMSW
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:KNOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:278 BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:ELSMERE
Mailing Address - State:DE
Mailing Address - Zip Code:19805-2504
Mailing Address - Country:US
Mailing Address - Phone:302-229-6101
Mailing Address - Fax:
Practice Address - Street 1:2644 KIRKWOOD HWY
Practice Address - Street 2:SUITE 250
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711
Practice Address - Country:US
Practice Address - Phone:302-683-1055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-11
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE0000102101YM0800X, 101YA0400X
DEQ3-0000250104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker