Provider Demographics
NPI:1548701956
Name:SHEILA CLARK
Entity type:Organization
Organization Name:SHEILA CLARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEMICAL DEPENDENCY COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC III
Authorized Official - Phone:419-722-8932
Mailing Address - Street 1:267 W CENTER ST APT 602
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-3679
Mailing Address - Country:US
Mailing Address - Phone:419-722-8932
Mailing Address - Fax:
Practice Address - Street 1:267 W CENTER ST APT 602
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-3679
Practice Address - Country:US
Practice Address - Phone:419-722-8932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011031251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health