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General NPI Number Information
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NPI Number | 1881263846
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Entity Type | Individual
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Provider Name | EMILY ELIZABETH CLARK
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Gender | Female
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Dates
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Enumeration Date | 06/23/2021
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Last Update Date | 07/24/2021
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Provider Practice Location Address
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Address Line | 147 N MILFORD RD STE 201
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City | HIGHLAND
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State | MI
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Zip | 48357-4500
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Country | US
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Telephone | 248-563-0587
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Fax |
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Provider Business Mailing Address
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Address Line | 2360 LANCASHIRE DR APT 2B
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City | ANN ARBOR
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State | MI
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Zip | 48105-1334
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Country | US
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Telephone | 734-752-1338
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801110288
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License Number State | MI
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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 | 6801110288
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License Number State | MI
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