Provider Demographics
NPI:1306027586
Name:CLARK, MARY HATTEN (MS)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:HATTEN
Last Name:CLARK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 JACKSONVILLE ST
Mailing Address - Street 2:
Mailing Address - City:WEAVER
Mailing Address - State:AL
Mailing Address - Zip Code:36277-4819
Mailing Address - Country:US
Mailing Address - Phone:256-848-9295
Mailing Address - Fax:
Practice Address - Street 1:804 JACKSONVILLE ST
Practice Address - Street 2:
Practice Address - City:WEAVER
Practice Address - State:AL
Practice Address - Zip Code:36277-4819
Practice Address - Country:US
Practice Address - Phone:256-848-9295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health