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General NPI Number Information
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NPI Number | 1760630875
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Entity Type | Individual
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Provider Name | ADRIA MICHELLE CLARK LLMSW
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Gender | Female
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 500 E POTTAWATAMIE ST
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City | TECUMSEH
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State | MI
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Zip | 49286-2018
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Country | US
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Telephone | 517-424-3337
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Fax |
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Provider Business Mailing Address
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Address Line | 1 SEAGATE STE 800
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City | TOLEDO
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State | OH
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Zip | 43604-1558
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Country | US
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Telephone | 419-824-7250
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Fax | 419-824-7359
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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 | 6801090664
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License Number State | MI
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