Samuel P. Clark, LMH
Counselor, Mental Health in Gainesville, FL. Individual provider (NPI-1).
NPI number1265742001
StatusActive
Last updated in NPPESOct 14, 2010
Details
- NPI
- 1265742001
- Entity type
- Individual (NPI-1)
- Name
- Mr. Samuel P. Clark
- Credential
- LMH
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Oct 14, 2010
- Last updated
- Oct 14, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YM0800X | Counselor, Mental Health | MH820 | FL | Yes |
| 101Y00000X | Counselor | MH820 | FL | |
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | MH820 | FL |
Practice location
1218 Nw 6th StreetGainesville, FL 32601
United States Minor Outlying Islands
Phone 352-244-0628 · Fax 352-334-3817
Mailing address
16243 Sw 143rd AveArcher, FL 32618-4778
Phone 352-244-0628 · Fax 352-334-3817
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