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NPI Code Detail

MEDICARE: PATRICIA CLARK LPC

MEDICARE: PATRICIA CLARK LPC
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
1101YM0800XMental Health Counselor0701009935VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10701009935OTHERVALPC LICENSE

General Provider Information

NPI Number : 1841897980
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICIA CLARK LPC
Provider Business Mailing Address
First Line : 701 KENMORE AVE STE 105
Second Line :
City : FREDERICKSBURG
State : VA
Zip : 22401-5792
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 701 KENMORE AVE STE 105
Second Line :
City : FREDERICKSBURG
State : VA
Zip : 22401-5792
Country : US
Telephone Number : 540-322-5424
Fax Number : 866-780-4133
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2020
Last Update Date : 10/01/2020

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Directions to “ PATRICIA CLARK LPC” Practice Location

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