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General NPI Number Information
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NPI Number | 1255549861
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Entity Type | Organization
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Legal Business Name | WILLIAM CLARK PHD AND ASSOCIATES, PLC
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2110 GALLOWS RD # B
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City | VIENNA
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State | VA
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Zip | 22182-3962
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Country | US
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Telephone | 703-506-8378
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Fax | 703-893-1011
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Provider Business Mailing Address
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Address Line | 2110 GALLOWS RD # B
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City | VIENNA
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State | VA
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Zip | 22182-3962
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Country | US
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Telephone | 703-506-8378
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Fax | 703-893-1011
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. WILLIAM W CLARK
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Credential | PHD
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Telephone | 703-506-8378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0810002215
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License Number State | VA
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