Active NPI
Colleen E Clark, LCPC/C
- Counselor
- Portland, ME
National Provider Identifier
1699336271
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- XL5223
- Practice address
- 901 Washington Ave Ste 100
Portland, ME 04103-2842 - Phone
- (207) 871-1200
- Fax
- (207) 871-1232
- NPI assigned
- Jun 25, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | XL5223 | ME | Primary |
Addresses
Primary practice location
901 Washington Ave Ste 100
Portland, ME 04103-2842
Mailing address
901 Washington Ave Ste 100
Portland, ME 04103-2842
Phone (207) 871-1200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| XL5223 | ME | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1561420800000",
"number": "1699336271",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "901 WASHINGTON AVE STE 100",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041032842",
"telephone_number": "207-871-1200",
"fax_number": "207-871-1232"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "901 WASHINGTON AVE STE 100",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041032842",
"telephone_number": "207-871-1200",
"fax_number": "207-871-1232"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "COLLEEN",
"middle_name": "E",
"credential": "LCPC/C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-06-25",
"last_updated": "2019-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "ME",
"license": "XL5223",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.