Organization
C CLARK LLC
Active
Other names
Brain Domain, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
CHANELLA LATRE CLARK LPCC (OWNER)
(615) 337-8709
Entity
Organization
Contact information
Practice address
210 25TH AVE NORTH, SUITE 601, ROOM 13, NASHVILLE, TN 37203
(615) 337-8709
Mailing address
1515 5TH AVE N APT 204, NASHVILLE, TN 37208-2798
(615) 337-8709
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/24/2022
Last updated
10/24/2022
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