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1992925960
GLORIA DEHAVEN CLARK
LONG BEACH, CA
NPI
1992925960
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2007-05-01
Last Update Date
2007-07-09
Business Address
-- GLORIA DEHAVEN CLARK CADCA
3125 E 7TH ST
LONG BEACH, CA 90804-4932
Phone number: 562-987-5742
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Mailing Address
-- GLORIA DEHAVEN CLARK CADCA
3125 E 7TH ST
LONG BEACH, CA 90804-4932
Phone number: 562-987-5742
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