Individual
JAMIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LCMHCA
Contact information
Practice address
14 HAZEL ST, CANTON, NC 28716-4109
(828) 455-4380
Mailing address
14 HAZEL ST, CANTON, NC 28716-4109
(828) 455-4380
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
A18885
NC
Other
Enumeration date
07/17/2023
Last updated
07/17/2023
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