Individual
GINA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1225 E BIG BEAVER RD, TROY, MI 48083-1905
(248) 524-8801
Mailing address
1225 E BIG BEAVER RD, TROY, MI 48083-1905
(248) 524-8801
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6803086525
MI
Other
Enumeration date
02/10/2014
Last updated
02/10/2014
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