Clark, Lisa
Clark, Lisa is an individual health care provider with primary practice located at 225 Medical Way , Riverdale GA 30274-2522. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Clark, Lisa can be contacted via phone (678) 519-1038.Contact Information
Primary practice address
225 Medical Way
Riverdale GA 30274-2522
Phone: (678) 519-1038
Fax: (770) 756-9195
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Behavioral Health & Social Service Providers / Clinical | 103TC0700X | PSY002509 | Georgia |
Profile Details
NPI number | 1952378226 |
---|---|
LBN Legal business name | Clark, Lisa |
Credentials | PH.D. |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Mar 4th, 2006 |
Last updated | Feb 10th, 2011 - 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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1952378226 | NPPES |
Georgia | MEDICAID | 000910929H | |
Georgia | MEDICAID | 000910929K | |
Georgia | MEDICAID | 000910929L | |
Georgia | MEDICAID | 000910929I | |
Georgia | MEDICAID | 000910929G | |
Georgia | MEDICAID | 000910929E | |
Georgia | MEDICAID | 000910929F |
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