Individual
AVA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1037 MAIN ST, PEEKSKILL, NY 10566-2913
(914) 734-8740
Mailing address
1037 MAIN ST, PEEKSKILL, NY 10566-2913
(914) 734-8740
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
13-2828349
—
NY
Enumeration date
01/16/2021
Last updated
01/16/2021
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