Provider Demographics
NPI:1972646990
Name:CLARK, LANA C
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:C
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 BLUESAGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-5205
Mailing Address - Country:US
Mailing Address - Phone:760-599-0804
Mailing Address - Fax:760-725-1267
Practice Address - Street 1:NAVAL HOSPITAL
Practice Address - Street 2:BLDG H 100, SANTA MARGARITA ROAD
Practice Address - City:CAMP PENDLET
Practice Address - State:CA
Practice Address - Zip Code:92055
Practice Address - Country:US
Practice Address - Phone:760-725-8882
Practice Address - Fax:760-725-1267
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical