Individual
BRANDI CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
107 INDUSTRIAL DR STE E, SAINT MARYS, GA 31558-4436
(912) 324-5012
Mailing address
10175 FORTUNE PKWY UNIT 903, JACKSONVILLE, FL 32256-6755
(904) 538-0713
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-18-54167
GA
Other
Enumeration date
04/25/2018
Last updated
04/25/2018
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