Individual
MISS BRAXTON CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
65 N WASHINGTON ST, WILKES BARRE, PA 18701-3100
(845) 606-1888
Mailing address
1612 CAPOUSE AVE APT 4, SCRANTON, PA 18509-1970
(845) 820-9345
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
08/02/2023
Last updated
08/02/2023
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