Individual
GARY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
100 SPENRYN DR, MADISON, AL 35758-1890
(256) 772-4400
Mailing address
100 SPENRYN DR, MADISON, AL 35758-1890
(256) 772-4400
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
19-93053
ID
Other
Enumeration date
11/27/2019
Last updated
11/27/2019
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