Provider Demographics
NPI:1255932299
Name:CLARK, MICHELE MAY (LAC)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:MAY
Last Name:CLARK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:KARAN
Other - Middle Name:MICHELE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:10800 FINANCIAL CENTRE PKWY STE 290
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3581
Mailing Address - Country:US
Mailing Address - Phone:501-781-2230
Mailing Address - Fax:
Practice Address - Street 1:10800 FINANCIAL CENTRE PKWY STE 290
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3581
Practice Address - Country:US
Practice Address - Phone:501-781-2230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2002020101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional