Provider Demographics
NPI:1447560636
Name:CLARK, DULIN W (PHD)
Entity Type:Individual
Prefix:DR
First Name:DULIN
Middle Name:W
Last Name:CLARK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 ALLEGHENY ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-2026
Mailing Address - Country:US
Mailing Address - Phone:814-505-3248
Mailing Address - Fax:
Practice Address - Street 1:416 ALLEGHENY ST FL 1
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-2026
Practice Address - Country:US
Practice Address - Phone:814-505-3248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS009217L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling