Individual
FANCHON MARIE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., LPC, CAADC
Contact information
Practice address
622 GRIGGS ST SE, GRAND RAPIDS, MI 49507-2644
(616) 901-1650
Mailing address
622 GRIGGS ST SE, GRAND RAPIDS, MI 49507-2644
(616) 901-1650
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401009405
MI
Other
Enumeration date
08/15/2017
Last updated
07/21/2022
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