Individual
DONNA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
294 W STATE ROUTE 89A, COTTONWOOD, AZ 86326-3754
(928) 639-5580
(928) 639-5641
Mailing address
1200 N BEAVER ST, PAYER CREDENTIALING, FLAGSTAFF, AZ 86001-3118
(928) 213-6235
(928) 213-6292
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-2322
AZ
Other
Enumeration date
09/14/2016
Last updated
09/14/2016
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