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General NPI Number Information
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NPI Number | 1033828744
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Entity Type | Individual
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Provider Name | CATHERINE CLARK LMSW
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Gender | Female
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Dates
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Enumeration Date | 11/21/2022
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Last Update Date | 01/23/2026
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Provider Practice Location Address
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Address Line | 1100 VICTORS WAY STE 10
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City | ANN ARBOR
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State | MI
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Zip | 48108-5220
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Country | US
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Telephone | 734-210-0117
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Fax |
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Provider Business Mailing Address
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Address Line | 32 N WASHINGTON ST STE 1
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City | YPSILANTI
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State | MI
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Zip | 48197-2662
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Country | US
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Telephone | 734-210-0116
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801121516
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License Number State | MI
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