Individual
DEBORAH A. CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
600 MEDICAL DR, SUITE A, HAMPTON, VA 23666-1769
(757) 788-0600
(757) 788-0932
Mailing address
2501 WASHINGTON AVE, 1ST FLOOR, NEWPORT NEWS, VA 23607-4327
(757) 245-0217
(757) 245-4918
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701003008
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
49-45573
—
VA
Enumeration date
08/30/2006
Last updated
07/09/2007
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