Healthcare Provider Details

I. General information

NPI: 1760733067
Provider Name (Legal Business Name): DONNAH CLARK-MILLER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 DRIFTWOOD LN
GRAYSON KY
41143-1614
US

IV. Provider business mailing address

181 DRIFTWOOD LN
GRAYSON KY
41143-1614
US

V. Phone/Fax

Practice location:
  • Phone: 606-744-4703
  • Fax:
Mailing address:
  • Phone: 606-744-4703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number172345
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number260504
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2607488
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: