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Individual

JAMES JACOB CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LPC

Contact information

Practice address
12351 DUTTON RD APT 1418, MIDLOTHIAN, VA 23113-4415
(571) 206-8137
Mailing address
12351 DUTTON RD APT 1418, MIDLOTHIAN, VA 23113-4415
(718) 249-6939

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
0022808
CO
101YM0800X
Mental Health Counselor
Primary
0701013896
VA

Other

Enumeration date
07/18/2022
Last updated
09/09/2025
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