JONATHAN BLAKE CLARKE

SOUTHPORT, NC
NPI1720458615
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: NC  LCAS-2729)
Enumeration Date2015-10-05
Last Update Date2023-12-06
Business Address
JONATHAN BLAKE CLARKE LCAS
1529 SHEPARD RD SE
SOUTHPORT, NC 28461-9435
Phone number: 704-249-4231
Mailing Address
JONATHAN BLAKE CLARKE LCAS
1529 SHEPARD RD SE
SOUTHPORT, NC 28461-9435
Phone number: 704-249-4231
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