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Individual
MS. KIMBERLY SUE CLARK
Active
Individual
MS. KIMBERLY SUE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHP
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
R6418
OR
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
17-04-02
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114058898
—
OR
Enumeration date
04/21/2016
Last updated
03/14/2023
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