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General NPI Number Information
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NPI Number | 1114989704
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Entity Type | Individual
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Provider Name | JODI ELEANOR CLARKE MA, LPC/MHSP, NCC
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Gender | Female
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Dates
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Enumeration Date | 04/06/2006
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Last Update Date | 04/22/2010
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Provider Practice Location Address
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Address Line | 9111 CROSS PARK DR BUILDING D, SUITE 200
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City | KNOXVILLE
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State | TN
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Zip | 37923-4506
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Country | US
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Telephone | 865-384-2172
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Fax |
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Provider Business Mailing Address
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Address Line | 8656 ABRAHAM LN
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City | KNOXVILLE
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State | TN
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Zip | 37931-3859
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Country | US
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Telephone | 865-384-2172
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH8550
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC 2392
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License Number State | TN
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