Provider Demographics
NPI:1992078315
Name:KLOCK, DHARMA
Entity type:Individual
Prefix:
First Name:DHARMA
Middle Name:
Last Name:KLOCK
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 1:335 RECORD ST
Mailing Address - Street 2:STE 155
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-3327
Mailing Address - Country:US
Mailing Address - Phone:775-324-2622
Mailing Address - Fax:775-324-0446
Practice Address - Street 1:335 RECORD ST
Practice Address - Street 2:STE 155
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-3327
Practice Address - Country:US
Practice Address - Phone:775-324-2622
Practice Address - Fax:775-324-0446
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker