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1134543226
LONNIE CLARK
ASHLAND, OR
NPI
1134543226
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: OR 13-12-10)
Enumeration Date
2014-02-10
Last Update Date
2014-02-10
Business Address
-- LONNIE CLARK CADC I
695 MISTLETOE RD STE H
ASHLAND, OR 97520-9552
Phone number: 541-482-8906
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Mailing Address
-- LONNIE CLARK CADC I
201 W MAIN ST STE 3D
MEDFORD, OR 97501-2744
Phone number: 541-779-2393
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