Individual
EDWARD CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
121 E ELWOOD AVE, RAEFORD, NC 28376-2947
(910) 875-8156
(910) 875-5579
Mailing address
PO BOX 9, WEST END, NC 27376-0009
(910) 673-9111
(910) 673-6202
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C000989
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6003566
—
NC
Enumeration date
08/01/2006
Last updated
03/25/2008
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