Individual
DR. CYNTHIA ADRIAN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
231 W MAIN ST, SUITE 2-W, CARBONDALE, IL 62901-2948
(618) 549-1793
(618) 549-1793
Mailing address
231 W MAIN ST STE 2-W, CARBONDALE, IL 62901-2948
(618) 549-1793
(618) 549-1793
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
039-72018
BLUE CROSS & BLUE SHIELD
IL
01
—
040796
HEALTH ALLIANCE
IL
01
—
189452
HEALTH LINK
IL
Enumeration date
03/16/2007
Last updated
07/08/2007
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