| NPI | 1932798261 |
|---|---|
| Former Name | STEPHANIE RUTH CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904012093) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC50079674) |
| Enumeration Date | 2021-01-12 |
| Last Update Date | 2021-01-12 |