Provider Demographics
NPI:1962834515
Name:CLARK, CARA MARIE (CSW)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:MARIE
Last Name:CLARK
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:
Other - Last Name:TYNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4615 GOVERNMENT ST
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-5922
Mailing Address - Country:US
Mailing Address - Phone:225-922-0445
Mailing Address - Fax:225-922-2658
Practice Address - Street 1:29437 HWY 63
Practice Address - Street 2:STE. 14
Practice Address - City:LIVINGSTON
Practice Address - State:LA
Practice Address - Zip Code:70754
Practice Address - Country:US
Practice Address - Phone:225-283-1356
Practice Address - Fax:225-283-1705
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041S0200X
LA123451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool