Individual
MRS. SANDRA DENICE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ED.S
Contact information
Practice address
5701 N HILLS ST, MERIDIAN, MS 39307-2903
(601) 581-7562
(601) 581-7676
Mailing address
PO BOX 4128, MERIDIAN, MS 39304-4128
(601) 581-7636
(601) 581-7676
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
0804
MS
101YM0800X
Mental Health Counselor
LH0061
MS
101YP2500X
Professional Counselor
Primary
0804
MS
101YS0200X
School Counselor
168226
MS
Other
Enumeration date
08/30/2010
Last updated
08/31/2010
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