| Lisa Clark Enterprises, Inc | |
|
2785 Lawrenceville Hwy Ste 207 Decatur GA 30033-2515 | |
| (678) 519-1038 | |
| (678) 239-4720 |
| Full Name | Lisa Clark Enterprises, Inc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 2785 Lawrenceville Hwy Ste 207, Decatur, Georgia |
| Authorized Official Name and Position | Lisa Clark (CEO/PRESIDENT/OWNER) |
| Authorized Official Contact | 4042763037 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lisa Clark Enterprises, Inc 2309 Norbury Cv Se Smyrna GA 30080-5206 Ph: (678) 519-1038 | Lisa Clark Enterprises, Inc 2785 Lawrenceville Hwy Ste 207 Decatur GA 30033-2515 Ph: (678) 519-1038 |
| NPI Number | 1801022413 |
|---|---|
| Provider Enumeration Date | 06/09/2009 |
| Last Update Date | 02/26/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801022413 | NPI | - | NPPES |
| 000910929O | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY002509 (Georgia) | Primary |
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