Organization
TAKING CHARGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GENEVA CLARK B.S. SOCIAL & BEHAVI (COORDINATOR)
(870) 540-7769
Entity
Organization
Contact information
Practice address
1116 S STATE ST, PINE BLUFF, AR 71601-5851
(870) 540-7769
(870) 247-1494
Mailing address
PO BOX 9802, PINE BLUFF, AR 71611-9802
(870) 540-7769
(870) 247-1494
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
—
—
Other
Enumeration date
08/02/2009
Last updated
08/02/2009
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