Individual
SUSAN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
914 E BROADWAY, 3RD FLOOR, LOUISVILLE, KY 40204-1037
(502) 589-8600
(502) 589-8771
Mailing address
101 W MUHAMMAD ALI BLVD, LOUISVILLE, KY 40202-1423
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
5049
KY
106H00000X
Marriage & Family Therapist
2013-007
KY
Other
Enumeration date
04/27/2011
Last updated
11/03/2015
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