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General NPI Number Information
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NPI Number | 1134010671
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Entity Type | Individual
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Provider Name | LAURA CLARK
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Gender | Female
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Dates
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Enumeration Date | 07/12/2025
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Last Update Date | 07/12/2025
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Provider Practice Location Address
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Address Line | 1601 MAPLE STREET UNIVERSITY OF WEST GEORGIA
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City | CARROLLTON
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State | GA
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Zip | 30118-0001
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Country | US
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Telephone | 678-677-1736
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Fax |
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Provider Business Mailing Address
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Address Line | 3147 MILFORD CHASE SW
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City | MARIETTA
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State | GA
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Zip | 30008-5786
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Country | US
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Telephone |
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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 | 101YS0200X
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Taxonomy Name | School Counselor
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License Number |
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License Number State |
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