Individual
KELLY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
120 BELLVIEW AVE, WINCHESTER, VA 22601-3142
(540) 542-0200
Mailing address
23 TAFT AVE APT 3, WINCHESTER, VA 22601-3696
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
07/05/2016
Last updated
07/05/2016
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