Individual
KATHY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., NCC, LPC
Contact information
Practice address
18 JACKSON ST, SUITE A, NEWNAN, GA 30263-1910
(678) 995-5398
Mailing address
18 JACKSON ST, SUITE A, NEWNAN, GA 30263-1910
(678) 995-5398
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPC009802
STATE OF GEORGIA
GA
Enumeration date
07/23/2014
Last updated
10/10/2017
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