Provider Demographics
NPI:1336617711
Name:CLARK, CAMECIA EUVONNE (LPC)
Entity type:Individual
Prefix:MISS
First Name:CAMECIA
Middle Name:EUVONNE
Last Name:CLARK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 FOUNTAIN VIEW DR STE 915
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-4821
Mailing Address - Country:US
Mailing Address - Phone:832-336-1650
Mailing Address - Fax:
Practice Address - Street 1:2401 FOUNTAIN VIEW DR STE 915
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-4821
Practice Address - Country:US
Practice Address - Phone:832-336-1650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2023-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker
No251B00000XAgenciesCase Management
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility