Individual
JENESIS E CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
3333 BURNET AVE ML 3015, CINCINNATI, OH 45229
(513) 636-4336
(513) 636-7756
Mailing address
5556 CLEARVIEW AVE, CINCINNATI, OH 45248-3216
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
E.2404016
OH
101YP2500X
Professional Counselor
E.2404016
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/14/2020
Last updated
03/20/2024
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