Individual
LATRICE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5226 WHETSTONE RD, N CHESTERFLD, VA 23234-4324
(336) 866-9248
Mailing address
5226 WHETSTONE RD, NORTH CHESTERFIELD, VA 23234-4324
(336) 866-9248
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
HCO-202031
VA
253Z00000X
In Home Supportive Care Agency
Primary
HCO-202031
VA
3747P1801X
Personal Care Attendant
HCO-202031
VA
376J00000X
Homemaker
HCO-202031
VA
376K00000X
Nurse's Aide
HCO-202031
VA
Other
Enumeration date
11/07/2019
Last updated
11/07/2019
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