Individual
JACKIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6130 ELTON AVE, LAS VEGAS, NV 89107-2538
(919) 710-4252
Mailing address
6130 ELTON AVE, LAS VEGAS, NV 89107-2538
(919) 710-4252
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
251S00000X
NV
Other
Enumeration date
01/15/2014
Last updated
01/15/2014
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