Individual
TIMOTHY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4215 9TH AVE S, FARGO, ND 58103-2018
(701) 478-9554
Mailing address
4215 9TH AVE S, FARGO, ND 58103-2018
(701) 478-9554
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1744
ND
Other
Enumeration date
05/06/2015
Last updated
05/06/2015
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