Provider Demographics
NPI:1972254761
Name:CLARK, AMIE (LPC)
Entity type:Individual
Prefix:MISS
First Name:AMIE
Middle Name:
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:PO BOX 8418
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71306-1418
Mailing Address - Country:US
Mailing Address - Phone:318-445-5678
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 8418
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71306-1418
Practice Address - Country:US
Practice Address - Phone:318-445-5678
Practice Address - Fax:318-441-9985
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8912101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional