MEDICARE: VIVIAN HOLLINS CLARK LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	39666	TX

General Provider Information

NPI Number	:	1023439015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN HOLLINS CLARK LCSW

Provider Business Mailing Address
First Line	:	2927 EBBTIDE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77045-4711
Country	:	US
Telephone Number	:	832-722-6893
Fax Number	:	832-825-0134

Provider Business Practice Location Address
First Line	:	2927 EBBTIDE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77045-4711
Country	:	US
Telephone Number	:	832-722-6893
Fax Number	:	832-825-0134

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2013
Last Update Date	:	09/18/2025

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Directions to “ VIVIAN HOLLINS CLARK LCSW” Practice Location

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