Individual
GWENDOLYN D CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
218 HOLIDAY HILLS DR, WILMINGTON, NC 28409-3514
(910) 612-0782
Mailing address
218 HOLIDAY HILLS DR, WILMINGTON, NC 28409-3514
(910) 612-0782
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
C002055
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1312U
BCBS #
NC
05
—
6106158
—
NC
01
—
C002055
LICENSE
NC
Enumeration date
04/26/2006
Last updated
03/11/2010
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