Individual
CHARLOTTE RENEE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4335 STEVE REYNOLDS BLVD, NORCROSS, GA 30093-3362
(770) 822-9115
Mailing address
1990 WILLOW TRAIL PKWY, NORCROSS, GA 30093-2665
(678) 900-6193
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/03/2021
Last updated
06/03/2021
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