Individual
DR. DIANE FAITH CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LEP 3014
Contact information
Practice address
25631 PETER A HARTMAN WAY, MISSION VIEJO, CA 92691-3142
(949) 580-3218
Mailing address
25631 PETER A HARTMAN WAY, MISSION VIEJO, CA 92691-3142
(949) 580-3218
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
3014
CA
Other
Enumeration date
02/01/2019
Last updated
02/01/2019
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