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Provider Information for 1205142106


The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

Mrs. SANDRA DENICE CLARK Ed.s


Sex: Female

NPI: 1205142106
Last Updated: 2010-08-31
Certification Date:

Details

NameValue
NPI1205142106
Enumeration Date2010-08-30
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address PO BOX 4128
MERIDIAN, MS 39304-4128
United States

Phone: 601-581-7636 | Fax:601-581-7676
 
Primary Practice Address 5701 N HILLS ST
MERIDIAN, MS 39307-2903
United States

Phone: 601-581-7562 | Fax:601-581-7676
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 101Y00000X - Counselor MS0804
No 101YM0800X - Counselor - Mental HealthMSLH0061
Yes 101YP2500X - Counselor - ProfessionalMS0804
No 101YS0200X - Counselor - SchoolMS168226