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Individual

ADAM CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
790 E 5TH ST, COQUILLE, OR 97423-1755
(541) 396-3111
Mailing address
940 E 5TH ST, COQUILLE, OR 97423-1699
(541) 396-3101

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
CSW.09924908
CO
1041C0700X
Clinical Social Worker
Primary
L8122
OR

Other

Enumeration date
02/28/2018
Last updated
09/03/2020
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