Individual
HUGH CLARK JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
100 BREWSTER BLVD, CAMP LEJEUNE, NC 28547-2575
(910) 440-2080
Mailing address
100 BREWSTER BLVD, CAMP LEJEUNE, NC 28547-2575
(910) 440-2080
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
C010704
NC
103TC1900X
Counseling Psychologist
SW11255
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12510840
CAQH
FL
01
—
C010704
LCSW
NC
01
—
SW11255
LCSW
FL
Enumeration date
06/19/2017
Last updated
05/10/2021
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