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General NPI Number Information
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NPI Number | 1619849643
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Entity Type | Organization
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Legal Business Name | DR. TRINESE CLARK, A LICENSED CLINICAL SOCIAL WORKER, INC.
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Dates
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Enumeration Date | 09/19/2025
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 550 FRONT ST UNIT 1504
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City | SAN DIEGO
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State | CA
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Zip | 92101-7094
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Country | US
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Telephone | 425-279-9922
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Fax |
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Provider Business Mailing Address
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Address Line | 550 FRONT ST UNIT 1504
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City | SAN DIEGO
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State | CA
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Zip | 92101-7094
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Country | US
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Telephone | 425-279-9922
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TRINESE CLARK
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Credential | DSW, LCSW
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Telephone | 619-366-8277
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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 |
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License Number State |
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