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Individual

HEATHER NICOLE CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MA, MFT

Contact information

Practice address
510 E CAROLINA AVE, HARTSVILLE, SC 29550-4396
(843) 332-4156
(843) 332-4159
Mailing address
510 E CAROLINA AVE, HARTSVILLE, SC 29550-4396
(843) 332-4156
(843) 332-4159

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
SC
101Y00000X
Counselor

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
NA
NA
Enumeration date
05/22/2018
Last updated
05/22/2018
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