Provider Demographics
NPI:1134937519
Name:CLARK, JAMAAL SR (LCSW-C)
Entity type:Individual
Prefix:MR
First Name:JAMAAL
Middle Name:
Last Name:CLARK
Suffix:SR
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6319 LEANING CYPRESS TRL
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-2184
Mailing Address - Country:US
Mailing Address - Phone:202-277-1238
Mailing Address - Fax:
Practice Address - Street 1:6319 LEANING CYPRESS TRL
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-2184
Practice Address - Country:US
Practice Address - Phone:202-277-1238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1096821041C0700X
MD269261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical