Organization
LISA CLARK ENTERPRISES, INC
Active
Organization
LISA CLARK ENTERPRISES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA CLARK PH.D. (CEO/PRESIDENT/OWNER)
(404) 276-3037
Entity
Organization
Contact information
Practice address
2785 LAWRENCEVILLE HWY STE 207, DECATUR, GA 30033-2515
(678) 519-1038
(678) 239-4720
Mailing address
2309 NORBURY CV SE, SMYRNA, GA 30080-5206
(678) 519-1038
(678) 239-4720
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY002509
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000910929O
—
GA
Enumeration date
06/09/2009
Last updated
02/26/2018
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