Individual
ANGELA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDCA
Contact information
Practice address
4449 STATE ROUTE 159, CHILLICOTHE, OH 45601-8620
(740) 775-1260
Mailing address
PO BOX 6159, CHILLICOTHE, OH 45601-6159
(740) 775-1260
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
141661
OH
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0096642
—
OH
Enumeration date
06/25/2018
Last updated
02/28/2023
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