Individual
GREGORY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3950 CHAIN BRIDGE RD, FAIRFAX, VA 22030-3935
(703) 665-9435
Mailing address
100 JAMES DR SE, VIENNA, VA 22180-6710
(571) 888-1895
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
03/03/2025
Last updated
03/03/2025
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