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Individual
FRED R CLARK
Active
Individual
FRED R CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSW
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1704
WV
1041C0700X
Clinical Social Worker
AP00941076
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1704
LPC
WV
01
—
AP00941076
LSW
WV
Enumeration date
10/11/2006
Last updated
02/27/2008
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