Individual
JAKAYLA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
210 CHARLOIS BLVD, WINSTON SALEM, NC 27103-1508
(336) 692-7965
Mailing address
210 CHARLOIS BLVD, WINSTON SALEM, NC 27103-1508
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
06/11/2019
Last updated
01/22/2024
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