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1396209136
WAYNE E CLARK
BRONX, NY
NPI
1396209136
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: NY 23387)
Enumeration Date
2019-01-25
Last Update Date
2019-01-25
Business Address
WAYNE E CLARK CASAC
820 SAINT ANNS AVE
BRONX, NY 10456-7885
Phone number: 646-316-3265
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Mailing Address
WAYNE E CLARK CASAC
2012 BENEDICT AVE STE 2
BRONX, NY 10462-4404
Phone number: 646-316-3265
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