Provider Demographics
NPI:1215409586
Name:CLARK, RANI KATRINA
Entity Type:Individual
Prefix:MRS
First Name:RANI
Middle Name:KATRINA
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3228 KINGS BAY CIR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-7123
Mailing Address - Country:US
Mailing Address - Phone:404-808-7206
Mailing Address - Fax:
Practice Address - Street 1:977A TAYLOR ST SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-5357
Practice Address - Country:US
Practice Address - Phone:678-209-2677
Practice Address - Fax:678-212-6309
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health