Individual
JEANNETTE B. CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSED., LPCC
Contact information
Practice address
941 RIVER RD, GRANVILLE, OH 43023-9534
(740) 587-1543
(740) 587-1573
Mailing address
PO BOX 279, UTICA, OH 43080-0279
(740) 759-1490
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
E.2001704
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1473276
—
OH
Enumeration date
02/19/2016
Last updated
06/18/2021
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