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Individual

RICHARD C CLARK III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MDCAC

Contact information

Practice address
800 PINEVIEW DR, HATTIESBURG, MS 39401-7459
(601) 705-1901
Mailing address
800 PINEVIEW DR, HATTIESBURG, MS 39401-7459
(601) 705-1901

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
AD97-012C
MS

Other

Enumeration date
08/13/2009
Last updated
08/13/2009
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