Individual ProviderAbraham Lewis ClarkCounselorBehavioral Health & Social Service ProvidersPractice Address1901 Cleveland Avenue, #B, Santa Rosa Treatment Program, Santa Rosa, CA 95401(707) 576-0818PECOS EnrollmentBased on the most recent information from CMS, provider Abraham Lewis Clark does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1720401367Provider TypeIndividualFull NameClark, Abraham LewisGenderMaleSole ProprietorNoEnumeration Date2/3/2014Last Updated2/3/2014Contact InformationPractice LocationPractice Address1901 Cleveland Avenue, #B, Santa Rosa Treatment Program, Santa Rosa, CA 95401Phone(707) 576-0818FaxUnlisted FaxMailing LocationMailing Address1901 Cleveland Avenue, #B, Santa Rosa Treatment Program, Santa Rosa, CA 95401Phone(707) 576-0818Fax(707) 576-7845Provider TaxonomiesCodeDescriptionLicenseCode101YA0400XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseRIC1401231658California