Individual
OWEN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
235 E PONCE DE LEON AVE STE 320, DECATUR, GA 30030-3452
(404) 692-2932
Mailing address
210 APPLEBY DR APT 216, ATHENS, GA 30605-5411
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
05/15/2024
Last updated
05/24/2024
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