Individual
MICHELE J CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
289 INDEPENDENCE BLVD, STE 245, VIRGINIA BEACH, VA 23462-5493
(757) 385-0850
(757) 518-9713
Mailing address
1305 ALMOND CT, CHESAPEAKE, VA 23323-5623
(757) 214-8758
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701003827
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861562472
—
VA
Enumeration date
08/02/2011
Last updated
08/02/2011
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