Most Relevant Information
Provider Data
| NPI Number: | 1003449976 |
| Provider Name: | AMANDA CLARK |
| Entity Type: | Individual |
| Taxonomy Code: | 101Y00000X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/19/2020 |
| Last Updated: | 02/19/2020 |
Provider Practice Location
1701 WHITE ST
MCCOMB
MS
396482711
Practice Location Phone/Fax
| Phone: | 6012494218 |
| Fax: | 6012494234 |
Provider Mailing Location
1701 WHITE ST
MCCOMB
MS
396482711
Provider Mailing Phone/Fax
| Phone: | 6012494218 |
| Fax: | 6012494234 |