Individual
JADA NYIESHA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
105 VICAR PL, DANVILLE, VA 24540-1241
(434) 272-8372
Mailing address
8100 RIVER RD, SOUTH BOSTON, VA 24592-6052
(434) 572-7528
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701013914
VA
Other
Enumeration date
08/26/2024
Last updated
08/26/2024
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