Individual
JONATHAN MICHAEL CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, MS, LPC, NBCC
Contact information
Practice address
1522B GREGG ST, PHILADELPHIA, PA 19115-4283
(215) 698-1978
Mailing address
1522B GREGG ST, PHILADELPHIA, PA 19115-4283
(215) 698-1978
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
PC008486
PA
101YS0200X
School Counselor
9350568
PA
Other
Enumeration date
11/23/2015
Last updated
11/23/2015
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