Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 66542 | TX |
NPI | 1003466947 |
---|---|
Provider Name | Ms. Eva-Sophia Clark |
First Address | Fort Worth, TX 76244-4245 |
Second Address | Denton, TX 76201-7423 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2019 |
Last Update Date | 21/03/2021 |