Provider Demographics
NPI:1215783410
Name:CLARK, SHEILA
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9266 ALMONDWILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-5402
Mailing Address - Country:US
Mailing Address - Phone:916-549-5038
Mailing Address - Fax:
Practice Address - Street 1:8153 ELK GROVE BLVD STE 20
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-5965
Practice Address - Country:US
Practice Address - Phone:916-925-3770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No251G00000XAgenciesHospice Care, Community Based