Individual
JERONIA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 MAIN ST, COLUMBUS, MS 39701-4751
(662) 328-9225
(662) 328-4735
Mailing address
302 N JACKSON ST, STARKVILLE, MS 39759-2504
(166) 252-4434
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124690334
—
MS
Enumeration date
07/15/2021
Last updated
08/11/2022
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