Individual
MRS. GENESE CALLOWAY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
458 GRAND AVE STE 103, NEW HAVEN, CT 06513-3873
(203) 850-4737
Mailing address
458 GRAND AVE STE 103, NEW HAVEN, CT 06513-3873
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/13/2020
Last updated
01/13/2020
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