Individual
CLARK G. BRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
3541 RANDOLPH RD, STE 206, CHARLOTTE, NC 28211-1082
(704) 381-8336
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
C008932
NC
1041C0700X
Clinical Social Worker
C008932
NC
Other
Enumeration date
05/11/2010
Last updated
07/15/2024
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