Individual
SHERRELL CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2085 RUSTIN AVE STE 1, RIVERSIDE, CA 92507-2498
(951) 955-7320
Mailing address
883 OLEANDER ST, HEMET, CA 92543-5876
(503) 754-2398
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
172V00000X
Community Health Worker
—
—
175T00000X
Peer Specialist
Primary
—
CA
175T00000X
Peer Specialist
—
—
Other
Enumeration date
10/07/2016
Last updated
12/31/2024
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