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Individual

KAYLA CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPC

Contact information

Practice address
106 E 5TH AVE, ROME, GA 30161-3128
(706) 509-0130
(706) 237-6503
Mailing address
406 LEAFMORE RD SW APT B, ROME, GA 30165-3856
(404) 736-5112

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
APC007128
GA
101YM0800X
Mental Health Counselor
Primary
LPC012786
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
LPC012786
LICENSURE
GA
Enumeration date
08/16/2017
Last updated
03/15/2022
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