MEDICARE: DAWN ALEXIS CLARK LLPC

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	101YP2500X	Professional Counselor	6401014204	MI

General Provider Information

NPI Number	:	1609380088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN ALEXIS CLARK LLPC

Provider Business Mailing Address
First Line	:	9541 SALEM
Second Line	:
City	:	REDFORD
State	:	MI
Zip	:	48239-1647
Country	:	US
Telephone Number	:	313-355-2137
Fax Number	:

Provider Business Practice Location Address
First Line	:	2965 MELDRUM ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-3402
Country	:	US
Telephone Number	:	313-355-2137
Fax Number	:

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

Provider Enumeration Date	:	11/21/2017
Last Update Date	:	06/16/2024

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