Individual
COLLEEN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
600 1ST AVE N STE 306, ST PETERSBURG, FL 33701-3609
(727) 283-4184
Mailing address
600 1ST AVE N STE 306, ST PETERSBURG, FL 33701-3609
(727) 283-4184
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
15359
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
O
NONE
—
Enumeration date
09/22/2018
Last updated
10/25/2021
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