Provider Demographics
NPI:1073702924
Name:CLARK, CARMAN SUZANNE (PSYCHOLOGIST, LPC)
Entity Type:Individual
Prefix:DR
First Name:CARMAN
Middle Name:SUZANNE
Last Name:CLARK
Suffix:
Gender:F
Credentials:PSYCHOLOGIST, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 LEE BYRD RD STE 11
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-2310
Mailing Address - Country:US
Mailing Address - Phone:678-215-7236
Mailing Address - Fax:
Practice Address - Street 1:149 LEE BYRD RD STE 11
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-2310
Practice Address - Country:US
Practice Address - Phone:678-215-7236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004465101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional