Provider Demographics
NPI:1902813850
Name:CLARK, JAMES DOUGLAS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DOUGLAS
Last Name:CLARK
Suffix:
Gender:M
Credentials:LCSW
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Other - First Name:
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Mailing Address - Street 1:4615 MARSH HAWK PL
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3027
Mailing Address - Country:US
Mailing Address - Phone:904-296-1055
Mailing Address - Fax:904-296-1953
Practice Address - Street 1:4203 SOUTHPOINT BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6164
Practice Address - Country:US
Practice Address - Phone:904-296-1055
Practice Address - Fax:904-296-1953
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLSW39941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical