Provider Demographics
NPI:1437709292
Name:CLARK, MARGIE
Entity Type:Individual
Prefix:
First Name:MARGIE
Middle Name:
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 1:3139 SE 8TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-2879
Mailing Address - Country:US
Mailing Address - Phone:352-361-3109
Mailing Address - Fax:
Practice Address - Street 1:2102 SW 20TH PL STE 302
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0858
Practice Address - Country:US
Practice Address - Phone:352-332-8588
Practice Address - Fax:352-332-8589
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician