Provider Demographics
NPI:1801580998
Name:CLARKE, SYANDENE LEOLA (LMSW)
Entity type:Individual
Prefix:
First Name:SYANDENE
Middle Name:LEOLA
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 LOGAN DR UNIT 2195
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-9524
Mailing Address - Country:US
Mailing Address - Phone:954-800-3433
Mailing Address - Fax:
Practice Address - Street 1:4047 NORTHRIDGE WAY APT 8
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3073
Practice Address - Country:US
Practice Address - Phone:954-800-3433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW011176104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker