Individual
CELESTINE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6415 STANLEY AVE, BERWYN, IL 60402-3130
(708) 995-3893
Mailing address
8453 S WABASH AVE, CHICAGO, IL 60619-5615
(773) 315-8614
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
05/31/2019
Last updated
05/31/2019
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