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Individual
DR. SUSAN MARIE CLARK
Active
Individual
DR. SUSAN MARIE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LPC005485
GA
101YP1600X
Pastoral Counselor
LPC005485
GA
101YP2500X
Professional Counselor
Primary
LPC005485
GA
Other
Enumeration date
02/25/2008
Last updated
01/05/2009
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