Healthcare Provider Details

I. General information

NPI: 1598239824
Provider Name (Legal Business Name): SANNA J CLARK PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2019
Last Update Date: 01/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 CANAL ST
NEW ORLEANS LA
70119-5947
US

IV. Provider business mailing address

1303 S RIDGE DR
MANDEVILLE LA
70448-1021
US

V. Phone/Fax

Practice location:
  • Phone: 504-270-9618
  • Fax:
Mailing address:
  • Phone: 985-502-1032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: