Provider Demographics
NPI:1881927523
Name:CLARK, CHERYL BETH (LCSW)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:BETH
Last Name:CLARK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:431 GROVE ST N
Mailing Address - Street 2:SUITE E
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-0437
Mailing Address - Country:US
Mailing Address - Phone:706-867-6798
Mailing Address - Fax:706-867-0265
Practice Address - Street 1:431 GROVE ST N
Practice Address - Street 2:SUITE E
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-0437
Practice Address - Country:US
Practice Address - Phone:706-867-6798
Practice Address - Fax:706-867-0265
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0021971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical