Most Relevant Information
Provider Data
| NPI Number: | 1003447616 |
| Provider Name: | DISHON CLARK |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/01/2020 |
| Last Updated: | 02/01/2020 |
Provider Practice Location
225 CEDAR HILL ST STE 200
MARLBOROUGH
MA
017525900
Practice Location Phone/Fax
| Phone: | 8505106013 |
| Fax: |
Provider Mailing Location
255 HONEYSUCKLE CIR APT 609
LAWRENCEVILLE
GA
300463223
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |