Clark, Elizabeth

Clark, Elizabeth is an individual health care provider with primary practice located at 780 E Gilbert St Suite 23 & 24, San Bernardino CA 92415-1003. She recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as her primary health care specialty. Clark, Elizabeth can be contacted via phone (909) 387-7458.

Contact Information

Primary practice address
780 E Gilbert St Suite 23 & 24 San Bernardino CA 92415-1003
Phone: (909) 387-7458
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 01-047276 California

Profile Details

NPI number 1508061615
LBN Legal business name Clark, Elizabeth
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 19th, 2007
Last updated Jun 16th, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508061615 NPPES
California Other 3145 SIMON STAFF NUMBER

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