Individual
MRS. ELEANOR ANN CLARK II
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA, CADC
Contact information
Practice address
84 MAIN ST, HACKENSACK, NJ 07601-7143
(201) 471-5694
Mailing address
84 MAIN ST, HACKENSACK, NJ 07601-7143
(201) 471-5694
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
37CA00065700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0183385
—
NJ
Enumeration date
07/15/2021
Last updated
07/15/2021
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