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General NPI Number Information
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NPI Number | 1184348328
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Entity Type | Individual
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Provider Name | MONIQUEA T CLARK M.DIV., E-RYT, YACEP
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Gender | Female
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Dates
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Enumeration Date | 09/30/2022
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Last Update Date | 09/30/2022
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Provider Practice Location Address
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Address Line | 2 OAKLAND ST
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City | TRENTON
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State | NJ
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Zip | 08618-3506
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Country | US
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Telephone | 609-532-1209
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Fax |
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Provider Business Mailing Address
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Address Line | 871 PARK AVE
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City | TRENTON
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State | NJ
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Zip | 08629-2123
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Country | US
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Telephone | 609-532-1209
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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 | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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