Individual
JENISE TRANNELL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
715 BRADLEY DR, FAYETTEVILLE, GA 30214-2030
(770) 358-5252
Mailing address
3777 WALDROP LN, DECATUR, GA 30034-6786
(404) 274-0929
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
Other
Enumeration date
05/04/2018
Last updated
03/22/2021
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