Individual
AUTUMN L CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
5125 N MARKET ST, SPOKANE, WA 99217-6131
(509) 838-4651
Mailing address
107 S DIVISION ST, SPOKANE, WA 99202-1510
(509) 838-4651
(509) 363-2762
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
CG60902893
WA
Other
Enumeration date
10/11/2018
Last updated
12/04/2018
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