Provider Demographics
NPI:1689988792
Name:RAMOS-CLARK, VEROINCA (LCAC, MHS)
Entity Type:Individual
Prefix:
First Name:VEROINCA
Middle Name:
Last Name:RAMOS-CLARK
Suffix:
Gender:F
Credentials:LCAC, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7108 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46324-2406
Mailing Address - Country:US
Mailing Address - Phone:219-933-7990
Mailing Address - Fax:219-933-7992
Practice Address - Street 1:7108 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46324-2406
Practice Address - Country:US
Practice Address - Phone:219-933-7990
Practice Address - Fax:219-933-7992
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000073A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)