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General NPI Number Information
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NPI Number | 1649380502
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Entity Type | Individual
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Provider Name | CLARK E WOOLDRIDGE JR. LISW ACP
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1220 MITCHELL
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City | CLOVIS
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State | NM
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Zip | 88101
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Country | US
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Telephone | 806-681-6745
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Fax | 505-742-3182
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Provider Business Mailing Address
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Address Line | 3519 TRIPP
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City | AMARILLO
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State | TX
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Zip | 79121
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Country | US
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Telephone | 806-359-4127
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Fax | 806-359-4127
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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 | I2267
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 05339
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License Number State | TX
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