Provider Demographics
NPI:1982276077
Name:CLARK, NINA (PSYD, LPC)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:PSYD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15261 SNOW FLAKE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-4435
Mailing Address - Country:US
Mailing Address - Phone:907-331-8854
Mailing Address - Fax:
Practice Address - Street 1:15261 SNOW FLAKE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-4435
Practice Address - Country:US
Practice Address - Phone:907-331-8854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK173084101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health