Individual
JILL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA MS LPC
Contact information
Practice address
1170 E CENTRAL AVE, WEST CARROLLTON, OH 45449-1825
(937) 865-9061
(937) 865-9069
Mailing address
1210 BERNA LN, KETTERING, OH 45429-5554
(937) 435-6623
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
C-5998
OH
Other
Enumeration date
05/03/2007
Last updated
07/08/2007
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