Individual
MR. STACY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M. ED
Contact information
Practice address
2156 SEASTONE TRCE, CHESAPEAKE, VA 23321-3777
(757) 803-5261
Mailing address
2156 SEASTONE TRCE, CHESAPEAKE, VA 23321-3777
(757) 405-6015
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
06/10/2009
Last updated
06/10/2009
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