Individual
MR. ANDREW PAUL CLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
9330 BASELINE RD STE 102, RANCHO CUCAMONGA, CA 91701
(951) 235-2372
(909) 981-2210
Mailing address
9330 BASELINE RD STE 102, RANCHO CUCAMONGA, CA 91701-5827
(951) 235-2372
(909) 981-2210
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
96297
CA
Other
Enumeration date
06/27/2013
Last updated
09/03/2018
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