Individual
MRS. CAROL LACESHIA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
139 PAULINE ST, JACKSON, SC 29831-3136
(803) 450-6770
Mailing address
139 PAULINE ST, JACKSON, SC 29831-3136
(803) 450-6770
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
46401
SC
Other
Enumeration date
09/20/2023
Last updated
09/20/2023
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