Individual
SHANNEN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COUNSELOR
Contact information
Practice address
526 OLD LIVERPOOL RD STE 9, LIVERPOOL, NY 13088-6285
(315) 453-3911
Mailing address
147 CUMBERLAND AVE, SYRACUSE, NY 13210-2211
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
12/27/2019
Last updated
12/22/2020
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