Individual
ADELINE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC-S
Contact information
Practice address
207 SUSANA DR, GEORGETOWN, TX 78628-8736
(443) 621-2835
Mailing address
207 SUSANA DR, GEORGETOWN, TX 78628-8736
(443) 621-2835
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPCS70788
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
816700100
—
MD
Enumeration date
05/10/2010
Last updated
12/28/2020
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