Individual
CHARISE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
904 MILL ST, COLFAX, LA 71417
(318) 627-5594
Mailing address
904 MILL ST, COLFAX, LA 71417-1032
(318) 627-5594
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/22/2016
Last updated
08/01/2018
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