Individual
VIRGINIA GAYLE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
4661 FOUNTAIN LN, ODESSA, TX 79761-1912
(432) 550-4089
Mailing address
4661 FOUNTAIN LANE, ODESSA, TX 79761
(432) 550-4089
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
13499
TX
Other
Enumeration date
07/07/2008
Last updated
07/07/2008
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