Individual
LESLEY A CLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
334 TIFTON ELDORADO RD, TIFTON, GA 31794-9497
(229) 386-3494
(229) 386-3221
Mailing address
334 TIFTON ELDORADO RD, P. O. BOX 1448, TIFTON, GA 31794-9497
(229) 386-3494
(229) 386-3221
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
LAPC1190
GA
101YP2500X
Professional Counselor
Primary
LPC005021
GA
Other
Enumeration date
02/19/2007
Last updated
02/08/2008
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