Individual
MS. MARY JOSEPHINE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., L.P.C.
Contact information
Practice address
4835 EASTERN AVE SE, SUITE 102, KENTWOOD, MI 49508-4729
(616) 262-9749
(866) 416-7581
Mailing address
1680 44TH ST SE UNIT 8074, GRAND RAPIDS, MI 49518-5005
(616) 262-9749
(866) 416-7581
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401005964
MI
Other
Enumeration date
01/25/2006
Last updated
05/02/2017
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