Individual
ABRAHAM LEWIS CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1901 CLEVELAND AVENUE, #B, SANTA ROSA TREATMENT PROGRAM, SANTA ROSA, CA 95401
(707) 576-0818
Mailing address
1901 CLEVELAND AVENUE, #B, SANTA ROSA TREATMENT PROGRAM, SANTA ROSA, CA 95401
(707) 576-0818
(707) 576-7845
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
RIC1401231658
CA
Other
Enumeration date
02/03/2014
Last updated
02/03/2014
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