Individual
ANTHONY MARTIN CLARK II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8946 INTERLINE AVE STE A, BATON ROUGE, LA 70809-1913
(225) 615-7282
Mailing address
4155 ESSEN LN APT 265, BATON ROUGE, LA 70809-2189
(225) 933-2840
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
010231785
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010231785
—
LA
Enumeration date
06/09/2017
Last updated
06/09/2017
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