Organization
KEEP A KID ON TRACK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM M CLARK JR. (PRESIDENT)
(305) 788-6269
Entity
Organization
Contact information
Practice address
623 PINE HILL ROAD, ORLANDO, FL 32808
(305) 788-6269
Mailing address
2425 FLOWER CORAL DR. SUITE 300, ORLANDO, FL 32808
(305) 788-6269
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YP1600X
Pastoral Counselor
—
—
101YP2500X
Professional Counselor
—
—
104100000X
Social Worker
—
—
225C00000X
Rehabilitation Counselor
—
—
Other
Enumeration date
03/01/2018
Last updated
03/01/2018
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