Provider Demographics
NPI:1891821278
Name:CLARK, ANGELA JANET (CATC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:JANET
Last Name:CLARK
Suffix:
Gender:F
Credentials:CATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E PARK AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6247
Mailing Address - Country:US
Mailing Address - Phone:805-349-0323
Mailing Address - Fax:
Practice Address - Street 1:412 E TUNNELL ST # B
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4146
Practice Address - Country:US
Practice Address - Phone:805-925-0315
Practice Address - Fax:805-346-1787
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)