| A Clark Minority Company Llc | |
|
4615 Marsh Hawk Pl Ponte Vedra Beach FL 32082-3027 | |
| (904) 463-1693 | |
| Not Available |
| Full Name | A Clark Minority Company Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 4615 Marsh Hawk Pl, Ponte Vedra Beach, Florida |
| Authorized Official Name and Position | James Douglas Clark (PRESIDENT/EO) |
| Authorized Official Contact | 9044631693 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| A Clark Minority Company Llc 4615 Marsh Hawk Pl Ponte Vedra Beach FL 32082-3027 Ph: (904) 463-1693 | A Clark Minority Company Llc 4615 Marsh Hawk Pl Ponte Vedra Beach FL 32082-3027 Ph: (904) 463-1693 |
| NPI Number | 1306385448 |
|---|---|
| Provider Enumeration Date | 02/22/2017 |
| Last Update Date | 02/22/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306385448 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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