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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 14 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 1588620538 NPPES
North Carolina MEDICAID 6106158
North Carolina Other 1312U
North Carolina Other C002055

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