Individual
DEJA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6180 GROVEDALE CT # 200, ALEXANDRIA, VA 22310-2552
(844) 244-1818
Mailing address
1500 DOUGLAS ROAD, SUITE 230, CORAL GABLES, FL 33134
(844) 854-1116
(305) 846-9711
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
70337054
—
DC
Enumeration date
06/30/2021
Last updated
06/30/2021
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