Individual
STEPHANIE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT, LPC
Contact information
Practice address
1175 CANTON ST, ROSWELL, GA 30075-3692
(404) 394-3748
Mailing address
320 SADDLE HILL CT, ROSWELL, GA 30075
(770) 674-1820
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
006348
GA
106H00000X
Marriage & Family Therapist
Primary
001264
GA
Other
Enumeration date
08/23/2017
Last updated
08/23/2017
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