Individual
ALISON CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
645 BALTIMORE ANNAPOLIS BLVD STE 216-217, SEVERNA PARK, MD 21146-3931
(800) 676-5130
(888) 958-5753
Mailing address
3208 GULF BREEZE PKWY, GULF BREEZE, FL 32563-3350
(800) 676-5130
(888) 958-5753
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C-462-048-603-386
DRIVER'S LICENSE
MD
Enumeration date
12/10/2018
Last updated
12/10/2018
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