Doctor Name: | DEBORAH CLARK |
NPI Number: | 1033536792 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.P.C. |
License Number: | PC004288 |
Business Practice Address: | 410 S Angle St Mount Joy, PA - 175522031 |
Business Phone Number: | 7176531507 |
Business Fax Number: | |
Mailing Address: | 30 Naomi Ave, LANDISVILLE |
State: | PA |
Postal Code: | 175381312 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 03/19/2014 |
NPI Last Update Date: | 03/19/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | PC004288 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |