Organization
A CLARK MINORITY COMPANY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES DOUGLAS CLARK LCSW,ACSW,CFRE (PRESIDENT/EO)
(904) 463-1693
Entity
Organization
Contact information
Practice address
4615 MARSH HAWK PL, PONTE VEDRA BEACH, FL 32082-3027
(904) 463-1693
Mailing address
4615 MARSH HAWK PL, PONTE VEDRA BEACH, FL 32082-3027
(904) 463-1693
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
02/22/2017
Last updated
02/22/2017
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