Provider Demographics
NPI:1639802408
Name:CLARK, DAVID CHRISTOPHER (MA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CHRISTOPHER
Last Name:CLARK
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1792 W LISBURN RD
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-9781
Mailing Address - Country:US
Mailing Address - Phone:223-269-7588
Mailing Address - Fax:
Practice Address - Street 1:4076 MARKET ST STE 100
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4200
Practice Address - Country:US
Practice Address - Phone:717-918-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health