Provider Demographics
NPI:1265867105
Name:CLARK, BRITTNEY (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 MCCULLOUGH DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3310
Mailing Address - Country:US
Mailing Address - Phone:704-615-4485
Mailing Address - Fax:
Practice Address - Street 1:542 WILLIAMSON RD
Practice Address - Street 2:SUITE 6
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8193
Practice Address - Country:US
Practice Address - Phone:704-615-4485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1687106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist