# JUDITH ANN CLARK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1861717597
- **Gender:** F
- **Credential:** MPS, EDS.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | F854398 | MI | — |
| 101YM0800X | Mental Health Counselor | F854398 | MI | Yes |

## Other

- **Enumeration date:** 04/06/2010
- **Last updated:** 04/06/2010