Clark, Gwendolyn D
Clark, Gwendolyn D is an sole proprietor health care provider with primary practice located at 218 Holiday Hills Dr , Wilmington NC 28409-3514. She recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as her primary health care specialty. Clark, Gwendolyn D can be contacted via phone (910) 612-0782.Contact Information
Primary practice address
218 Holiday Hills Dr
Wilmington NC 28409-3514
Phone: (910) 612-0782
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | C002055 | North Carolina |
Profile Details
| NPI number | 1588620538 |
|---|---|
| LBN Legal business name | Clark, Gwendolyn D |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 26th, 2006 |
| Last updated | Mar 11th, 2010 - about 15 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1588620538 | NPPES |
| North Carolina | MEDICAID | 6106158 | |
| North Carolina | Other | 1312U | |
| North Carolina | Other | C002055 |
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