Doctor Name: | JAMES CLARK |
NPI Number: | 1336595412 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | RI-C1402181903 |
Business Practice Address: | 1152 Sonoma Ave Seaside, CA - 939555218 |
Business Phone Number: | 8318992436 |
Business Fax Number: | |
Mailing Address: | 1152 Sonoma Ave, SEASIDE |
State: | CA |
Postal Code: | 939555218 |
Phone Number: | 8318992436 |
Fax Number: | |
NPI Enumeration Date: | 05/09/2016 |
NPI Last Update Date: | 05/09/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | RI-C1402181903 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |