Individual
MR. GARY E. CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
7529 CINNABAR TER, GAITHERSBURG, MD 20879-4576
(301) 917-7947
Mailing address
7529 CINNABAR TER, GAITHERSBURG, MD 20879-4576
(301) 917-7947
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LC 0902
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051700300
—
MD
Enumeration date
06/08/2006
Last updated
01/31/2022
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