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General NPI Number Information
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NPI Number | 1982402871
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Entity Type | Individual
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Provider Name | SHAWNA P CLARK CBHCMS, CMHP, HS-BCP
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Gender | Female
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 2200 ROSSELLE ST
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City | JACKSONVILLE
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State | FL
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Zip | 32204-3126
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Country | US
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Telephone | 904-551-2399
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 RIVERPLACE BLVD APT 811
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City | JACKSONVILLE
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State | FL
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Zip | 32207-9079
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Country | US
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Telephone | 912-278-0403
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 0102782
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License Number State | FL
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