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General NPI Number Information
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NPI Number | 1669056305
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Entity Type | Individual
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Provider Name | DEBBIE CLARK LPC
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Gender | Female
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Dates
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Enumeration Date | 05/10/2021
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Last Update Date | 09/27/2024
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Provider Practice Location Address
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Address Line | 1205 E DIXON RD
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City | LITTLE ROCK
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State | AR
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Zip | 72206-4171
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Country | US
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Telephone | 501-234-2020
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Fax | 501-588-2780
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Provider Business Mailing Address
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Address Line | PO BOX 509
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City | DERMOTT
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State | AR
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Zip | 71638-0509
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Country | US
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Telephone | 870-942-3000
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Fax | 870-538-5412
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | P2409010
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License Number State | AR
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