Individual
CHRISTINA LYNN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2143 NE BROADWAY ST, PORTLAND, OR 97232-1512
(917) 912-9505
Mailing address
2581 NE 31ST AVE, PORTLAND, OR 97212-3660
(917) 912-9505
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6547
OR
Other
Enumeration date
09/16/2009
Last updated
09/25/2017
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