Individual
MARY A CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1821 UNIVERSITY AVE W STE N385, SAINT PAUL, MN 55104-2872
(952) 679-5392
(651) 647-9147
Mailing address
1821 UNIVERSITY AVE W STE N385, SAINT PAUL, MN 55104-2872
(952) 679-5392
(651) 647-9147
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
305068
MN
Other
Enumeration date
01/30/2019
Last updated
01/30/2019
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