Provider Demographics
NPI:1881966208
Name:CLARK-GEORGE, VERONICA
Entity type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:
Last Name:CLARK-GEORGE
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 1:721 HYDRANGEA CIR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-7258
Mailing Address - Country:US
Mailing Address - Phone:704-615-9344
Mailing Address - Fax:
Practice Address - Street 1:301 MCCULLOUGH DR
Practice Address - Street 2:SUITE 400
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3310
Practice Address - Country:US
Practice Address - Phone:704-400-1971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0144501041C0700X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical