Individual
KELLY MARIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AAC
Contact information
Practice address
811 MADISON ST, EVERETT, WA 98203-4543
(425) 212-4200
(425) 212-4201
Mailing address
1100 S 2ND ST, MOUNT VERNON, WA 98273-4209
(360) 419-3500
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
175T00000X
Peer Specialist
Primary
1477897916
WA
Other
Enumeration date
11/22/2012
Last updated
03/17/2018
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