Clark, Justin

Clark, Justin is an individual health care provider with primary practice located at 1280 Central Dr , Southern Pines NC 28387-2102. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Developmental Therapist, which is considered as his primary health care specialty. Clark, Justin can be contacted via phone (910) 692-3323.

Contact Information

Primary practice address
1280 Central Dr Southern Pines NC 28387-2102
Phone: (910) 692-3323
Fax: (910) 692-1114
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Developmental Therapist 222Q00000X

Profile Details

NPI number 1114360807
LBN Legal business name Clark, Justin
Credentials BA HISTORY
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 11th, 2013
Last updated Apr 11th, 2013 - about 12 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 1114360807 NPPES
North Carolina MEDICAID 8300012

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