Provider Demographics
NPI:1821989831
Name:CLARK, ANDRAMIKA
Entity type:Individual
Prefix:
First Name:ANDRAMIKA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8657 HOSPITAL DR STE 102A
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-5614
Mailing Address - Country:US
Mailing Address - Phone:404-850-5244
Mailing Address - Fax:
Practice Address - Street 1:8657 HOSPITAL DR STE 102A
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5614
Practice Address - Country:US
Practice Address - Phone:404-850-5244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling