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
Fax: (770) 756-9195
Website:

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
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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