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General NPI Number Information
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NPI Number | 1770149619
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Entity Type | Individual
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Provider Name | WILL CLARK MS, APC, NCC
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Gender | Male
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Dates
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Enumeration Date | 05/16/2019
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Last Update Date | 05/16/2019
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Provider Practice Location Address
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Address Line | 2336 WISTERIA DR STE 440
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City | SNELLVILLE
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State | GA
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Zip | 30078-6160
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Country | US
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Telephone | 404-664-7494
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Fax |
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Provider Business Mailing Address
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Address Line | 3228 KINGS BAY CIR
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City | DECATUR
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State | GA
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Zip | 30034-7123
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Country | US
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Telephone | 404-664-7494
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | APC006757
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License Number State | GA
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