Provider Demographics
NPI:1114777091
Name:CLARK, BRITTANY (RBT)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 CONFROY DR STE 4
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-7163
Mailing Address - Country:US
Mailing Address - Phone:434-835-9007
Mailing Address - Fax:434-323-3001
Practice Address - Street 1:1100 CONFROY DR STE 4
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-7163
Practice Address - Country:US
Practice Address - Phone:434-835-9007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician