Doctor Name: | MRS. SANDRA DENICE CLARK |
NPI Number: | 1205142106 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ED.S |
License Number: | 0804 |
Business Practice Address: | 5701 N Hills St Meridian, MS - 393072903 |
Business Phone Number: | 6015817562 |
Business Fax Number: | 6015817676 |
Mailing Address: | Po Box 4128, MERIDIAN |
State: | MS |
Postal Code: | 393044128 |
Phone Number: | 6015817636 |
Fax Number: | 6015817676 |
NPI Enumeration Date: | 08/30/2010 |
NPI Last Update Date: | 08/31/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 0804 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MS |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |