Individual
FRED R CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
1020 GROSSCUP AVE, DUNBAR, WV 25064-3128
(304) 525-7851
(304) 525-1073
Mailing address
107 SUMMERBROOK LANE, HURRICANE, WV 25526
(304) 525-7851
(304) 525-1073
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1704
WV
1041C0700X
Clinical Social Worker
AP00941076
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1704
LPC
WV
01
—
AP00941076
LSW
WV
Enumeration date
10/11/2006
Last updated
02/27/2008
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