Provider Demographics
NPI:1316664006
Name:C CLARK LLC
Entity type:Organization
Organization Name:C CLARK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANELLA
Authorized Official - Middle Name:LATRE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:615-337-8709
Mailing Address - Street 1:1515 5TH AVE N APT 204
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-2798
Mailing Address - Country:US
Mailing Address - Phone:615-337-8709
Mailing Address - Fax:
Practice Address - Street 1:210 25TH AVE NORTH
Practice Address - Street 2:SUITE 601, ROOM 13
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203
Practice Address - Country:US
Practice Address - Phone:615-337-8709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty