Individual
ALICE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10720 E. MARIGOLD LANE, FLORENCE, AZ 85232
(520) 723-8228
Mailing address
10720 E. MARIGOLD LANE, FLORENCE, AZ 85232
(520) 723-8228
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
10784
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
988321
AHCCCS ID
AZ
Enumeration date
11/30/2006
Last updated
07/08/2007
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