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General NPI Number Information
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NPI Number | 1942580527
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Entity Type | Organization
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Legal Business Name | CLARK COUNSELING AND CONSULTING LLC
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Dates
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Enumeration Date | 08/26/2011
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Last Update Date | 12/18/2018
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Provider Practice Location Address
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Address Line | 416 ALLEGHENY ST FL 1
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City | HOLLIDAYSBURG
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State | PA
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Zip | 16648-2026
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Country | US
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Telephone | 814-505-3248
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Fax |
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Provider Business Mailing Address
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Address Line | 416 ALLEGHENY ST
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City | HOLLIDAYSBURG
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State | PA
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Zip | 16648-2026
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Country | US
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Telephone | 814-505-3248
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. DULIN WAYNE CLARK
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Credential | PH.D.
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Telephone | 814-505-3248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PS009217L
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License Number State | PA
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