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General NPI Number Information
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NPI Number | 1689564924
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Entity Type | Organization
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Legal Business Name | CLARK NP IN PSYCHIATRY SERVICES P.C.
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Dates
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Enumeration Date | 07/08/2025
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 30 WALL ST FL 8
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City | NEW YORK
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State | NY
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Zip | 10005-2205
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Country | US
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Telephone | 347-460-9267
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Fax |
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Provider Business Mailing Address
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Address Line | 820 MICHELLE MNR
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City | MONTEVALLO
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State | AL
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Zip | 35115-1111
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Country | US
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Telephone | 205-936-0429
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SHALITA R CLARK
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Credential | PMHNP
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Telephone | 347-460-9267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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