Individual
NICKEISHA CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
4729 US 98 S, SUITE 104, LAKELAND, FL 33812-4323
(863) 877-1855
(863) 646-6111
Mailing address
4729 US 98 S STE 104, LAKELAND, FL 33812-4323
(863) 877-1855
(863) 646-6111
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY9310
FL
Other
Enumeration date
08/21/2018
Last updated
08/21/2018
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