Provider Demographics
NPI:1851542534
Name:CLARK, GEORGE WARREN (LMSW)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:WARREN
Last Name:CLARK
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 LOMBARDY DR
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-9586
Mailing Address - Country:US
Mailing Address - Phone:734-475-8244
Mailing Address - Fax:
Practice Address - Street 1:6750 LOMBARDY DR
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-9586
Practice Address - Country:US
Practice Address - Phone:734-475-8244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010340431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical