Individual
PATRICIA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
701 KENMORE AVE STE 105, FREDERICKSBURG, VA 22401-5792
(540) 322-5424
(866) 780-4133
Mailing address
701 KENMORE AVE STE 105, FREDERICKSBURG, VA 22401-5792
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0701009935
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0701009935
LPC LICENSE
VA
Enumeration date
10/01/2020
Last updated
10/01/2020
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