Individual
SHANAVIER CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15024 MARTIN LUTHER KING JR BLVD, GULFPORT, MS 39501-8306
(228) 864-0003
(228) 863-7917
Mailing address
10467 CORPORATE DR, GULFPORT, MS 39503-4634
(228) 374-2494
(228) 396-3457
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
104100000X
Social Worker
Primary
C11808
MS
Other
Enumeration date
05/21/2018
Last updated
11/24/2025
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