Provider Demographics
NPI:1942344163
Name:CLARK, AIMEE LE ZAKREWSKI (MFT)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:LE ZAKREWSKI
Last Name:CLARK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10951 SORRENTO VALLEY RD STE G
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1603
Mailing Address - Country:US
Mailing Address - Phone:760-803-3600
Mailing Address - Fax:
Practice Address - Street 1:10951 SORRENTO VALLEY RD STE 2G
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1613
Practice Address - Country:US
Practice Address - Phone:760-803-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43637106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist