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General NPI Number Information
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NPI Number | 1972254761
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Entity Type | Individual
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Provider Name | AMIE CLARK LPC
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Gender | Female
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Dates
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Enumeration Date | 01/12/2022
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | PO BOX 8418
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City | ALEXANDRIA
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State | LA
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Zip | 71306-1418
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Country | US
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Telephone | 318-445-5678
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Fax | 318-441-9985
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Provider Business Mailing Address
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Address Line | PO BOX 8418
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City | ALEXANDRIA
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State | LA
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Zip | 71306-1418
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Country | US
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Telephone | 318-445-5678
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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 | 8912
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License Number State | LA
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