Individual
ASHLEY NICOLE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PREVENTION SPECIALIS
Contact information
Practice address
1212 BATH AVE FL 8, ASHLAND, KY 41101-2696
(606) 329-8588
Mailing address
PO BOX 790, ASHLAND, KY 41105-0790
(606) 329-8588
(606) 329-8195
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
405300000X
Prevention Professional
Primary
NOTCERTIFIED
KY
Other
Enumeration date
10/15/2018
Last updated
02/14/2020
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