Provider Demographics
NPI:1326185703
Name:DEBBIE CLARK SUPPORT SERVICES INC.
Entity Type:Organization
Organization Name:DEBBIE CLARK SUPPORT SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:KAREN
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-432-5777
Mailing Address - Street 1:426 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-3225
Mailing Address - Country:US
Mailing Address - Phone:850-432-5777
Mailing Address - Fax:850-478-6578
Practice Address - Street 1:426 TANGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-3225
Practice Address - Country:US
Practice Address - Phone:850-432-5777
Practice Address - Fax:850-478-6578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251C00000X251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services