Individual
MRS. CAROL DENISE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
3905 GRISSOM PKWY, COCOA, FL 32926-3669
(321) 637-1866
(321) 637-7227
Mailing address
6975 BISMARCK ROAD, COCOA, FL 32927-3955
(407) 595-9535
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MH10894
FL
Other
Enumeration date
09/01/2011
Last updated
09/01/2011
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