Provider Demographics
NPI:1487346474
Name:HOPKINS CLARK, JUSTIN ALLAN (LSW)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:ALLAN
Last Name:HOPKINS CLARK
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8555 MCKINLEY ST APT Q458
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-8817
Mailing Address - Country:US
Mailing Address - Phone:219-331-8509
Mailing Address - Fax:
Practice Address - Street 1:8555 MCKINLEY ST APT Q458
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-8817
Practice Address - Country:US
Practice Address - Phone:219-331-8509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33009992A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker