Provider Demographics
NPI:1598216814
Name:CLARK& ASSOCIATES
Entity Type:Organization
Organization Name:CLARK& ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT CONTRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIERRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-527-2785
Mailing Address - Street 1:330 N CHARLES ST
Mailing Address - Street 2:4B
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-4304
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 N CHARLES ST
Practice Address - Street 2:4B
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4304
Practice Address - Country:US
Practice Address - Phone:443-527-2785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health