Individual
THERESA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5248 OLDE TOWNE RD, WILLIAMSBURG, VA 23188-1986
(757) 603-4603
Mailing address
62 PRIORSLEE LN, WILLIAMSBURG, VA 23185-4864
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0704016012
VA
Other
Enumeration date
09/12/2023
Last updated
09/12/2023
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