Individual
MR. JOHN E CLARK III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10390 DEMOCRACY LN, FAIRFAX, VA 22030-2522
(703) 219-2578
Mailing address
11561 SHADBUSH CT, RESTON, VA 20191-3009
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0710101131
VA
Other
Enumeration date
01/09/2007
Last updated
07/08/2007
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