Provider Demographics
NPI:1598239824
Name:CLARK, SANNA J (PLPC)
Entity Type:Individual
Prefix:
First Name:SANNA
Middle Name:J
Last Name:CLARK
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 S RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-1021
Mailing Address - Country:US
Mailing Address - Phone:985-502-1032
Mailing Address - Fax:
Practice Address - Street 1:4440 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-5947
Practice Address - Country:US
Practice Address - Phone:504-270-9618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health