Healthcare Provider Details

I. General information

NPI: 1235451139
Provider Name (Legal Business Name): APRIL CLARK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 KENDALL HILL RD
WILLOW SPRING NC
27592-9070
US

IV. Provider business mailing address

1621 KENDALL HILL RD
WILLOW SPRING NC
27592-9070
US

V. Phone/Fax

Practice location:
  • Phone: 919-753-5906
  • Fax:
Mailing address:
  • Phone: 919-753-5906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC006723
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: