Provider Demographics
NPI:1730668864
Name:CLARK, RAYSHA (LPC)
Entity Type:Individual
Prefix:
First Name:RAYSHA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 W MARKHAM ST STE 203
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2181
Mailing Address - Country:US
Mailing Address - Phone:501-424-0555
Mailing Address - Fax:501-500-2666
Practice Address - Street 1:10201 W MARKHAM ST STE 203
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2181
Practice Address - Country:US
Practice Address - Phone:501-424-0555
Practice Address - Fax:501-500-2666
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1808105101YM0800X
ARP2012127101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health