| Doctor Name: | EDWARD CLARK |
| NPI Number: | 1043570732 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC., CCADC |
| License Number: | |
| Business Practice Address: | 4015 Nine Mcfarland Dr Suite #175 Alpharetta, GA - 300048493 |
| Business Phone Number: | 6789829039 |
| Business Fax Number: | 4702358705 |
| Mailing Address: | 4015 Nine Mcfarland Dr, Suite #175 ALPHARETTA |
| State: | GA |
| Postal Code: | 300048493 |
| Phone Number: | 6789829039 |
| Fax Number: | 4702358705 |
| NPI Enumeration Date: | 05/29/2012 |
| NPI Last Update Date: | 08/04/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |