Individual
STACEY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
TCADC
Contact information
Practice address
1200 MASTER ST, CORBIN, KY 40701-2502
(606) 280-4000
(833) 222-3797
Mailing address
PO BOX 2634, CORBIN, KY 40702-2634
(606) 280-4000
(833) 222-3797
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
300934
KY
Other
Enumeration date
09/11/2025
Last updated
09/11/2025
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