Individual
ANNIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
118 HWY 605, NEWELLTON, LA 71357
(318) 467-2399
(318) 467-2400
Mailing address
118 HWY 605, NEWELLTON, LA 71357
(318) 467-2399
(318) 467-2400
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000
COUNSELOR
LA
Enumeration date
12/09/2015
Last updated
12/09/2015
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