Individual
DAVITA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5770 HIGHLAND RD, WATERFORD, MI 48327-1877
(248) 301-1080
Mailing address
5770 HIGHLAND RD, WATERFORD, MI 48327-1877
(248) 301-1080
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6851121495
MI
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
08/11/2025
Last updated
02/24/2026
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