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Contact Information

LISA CLARK ENTERPRISES, INC
2785 LAWRENCEVILLE HWY STE 207
DECATUR, GA30033-2515
 Phone: 678-519-1038
 Fax: 678-239-4720
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for LISA CLARK ENTERPRISES INC · (Female)

NPI Number 1801022413
Status Active
Credentials
Entity Individual
Enumeration date 06/09/2009
Last updated 02/26/2018 - About 8 years ago
Sole proprietor 1 Not specified
Identifiers
  • GA License # PSY002509
  • GA Medicaid 000910929O
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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