| NPI | 1548427347 |
|---|---|
| Former Name | LISA CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA CAS CO409281508) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA c058030618) |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2022-03-17 |