Individual
SANDRA LOUISE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NCACII, LADC, CCJP
Contact information
Practice address
1885 UNIVERSITY AVE W, SUITE 20, SAINT PAUL, MN 55104-3489
(651) 373-0152
(763) 767-3145
Mailing address
1885 UNIVERSITY AVE W, SUITE 20, SAINT PAUL, MN 55104-3489
(651) 373-0152
(763) 767-3145
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
301712
MN
Other
Enumeration date
02/26/2008
Last updated
02/26/2008
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