Basic Information
| Provider Information | |||||||||
| NPI: | 1760845077 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLARK | ||||||||
| FirstName: | CLAUDIA | ||||||||
| MiddleName: | E. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 BEECHWOOD AVE NE APT 12 | ||||||||
| Address2: | |||||||||
| City: | NORTH CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447201681 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2685 ARMSTRONG RD | ||||||||
| Address2: | |||||||||
| City: | WOOSTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446919041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303457949 | ||||||||
| FaxNumber: | 3303454218 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2016 | ||||||||
| LastUpdateDate: | 04/04/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | C.1400177 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.