Individual
DR. LAURA KATHLEEN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
305 WASHINGTON ST SW, BLACKSBURG, VA 24060-4745
(540) 552-3046
Mailing address
3464 SPUR ST, BLACKSBURG, VA 24060-8750
(540) 951-2872
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810001506
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7755023
—
VA
Enumeration date
01/24/2007
Last updated
07/08/2007
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