Individual
MS. CONNIE LYNN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.ED., LCPC
Contact information
Practice address
955 S DURKIN DR, STE. B, SPRINGFIELD, IL 62704-1370
(217) 753-1288
Mailing address
955 S DURKIN DR, STE. B, SPRINGFIELD, IL 62704-1370
(217) 753-1288
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
180.006792
IL
101YM0800X
Mental Health Counselor
180.006792
IL
101YP2500X
Professional Counselor
Primary
180.006792
IL
Other
Enumeration date
11/01/2006
Last updated
11/08/2008
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