Provider Demographics
NPI:1063050300
Name:CLARK, ABBY PULLEN (PHD)
Entity type:Individual
Prefix:DR
First Name:ABBY
Middle Name:PULLEN
Last Name:CLARK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 ASHMALINE LN
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-3157
Mailing Address - Country:US
Mailing Address - Phone:256-282-6914
Mailing Address - Fax:
Practice Address - Street 1:801 NOBLE ST STE 400
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-5698
Practice Address - Country:US
Practice Address - Phone:267-770-4083
Practice Address - Fax:256-405-4997
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2154103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical