Individual
MADISON CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11615 NORTHGATE TRL, ROSWELL, GA 30075-2335
(678) 643-5421
Mailing address
11615 NORTHGATE TRL, ROSWELL, GA 30075-2335
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
05/03/2016
Last updated
05/03/2016
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