Individual
DORTHEA A CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA IN MENTAL HEALTH
Contact information
Practice address
4025 RAWLINS ST, CHEYENNE, WY 82001-1900
(307) 426-4797
Mailing address
4025 RAWLINS ST, CHEYENNE, WY 82001-1900
(307) 631-7381
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
PPC-1416
WY
Other
Enumeration date
11/15/2023
Last updated
11/15/2023
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