Individual
CARLA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2440 DAWNLIGHT AVE, COLUMBUS, OH 43211-1934
(614) 481-5050
Mailing address
2440 DAWNLIGHT AVE, COLUMBUS, OH 43211-1934
(614) 481-5050
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
ICDC.111008-CS
OH
1041C0700X
Clinical Social Worker
Primary
I.900145
OH
Other
Enumeration date
01/29/2016
Last updated
01/29/2016
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