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Organization
MANTHERS PLACE COUNSELING
Active
Organization
MANTHERS PLACE COUNSELING
Active
Parent organization
MANTHERS PLACE COUNSELING
Organization subpart
Yes
Provider details
NPI number
Legal business name
MANTHERS PLACE COUNSELING
Authorized official
CONNIE ELLETTA CLARK MA, LMHC, CST,MAC (THERAPIST)
(904) 743-2327
Entity
Organization
Contact information
Practice address
6108 ARLINGTON RD, JACKSONVILLE, FL 32211-5420
(904) 743-2353
Mailing address
6108 ARLINGTON RD, JACKSONVILLE, FL 32211-5420
(904) 743-2353
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
MH14118
FL
101YM0800X
Mental Health Counselor
Primary
MH14118
FL
Other
Enumeration date
02/16/2017
Last updated
02/16/2017
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