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General NPI Number Information
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NPI Number | 1215260666
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Entity Type | Organization
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Legal Business Name | CLARK COUNSELING & CONSULTING, INC.
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Dates
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Enumeration Date | 09/16/2009
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Last Update Date | 02/23/2024
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Provider Practice Location Address
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Address Line | 2386 CLOWER ST STE D-100
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City | SNELLVILLE
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State | GA
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Zip | 30078-6134
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Country | US
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Telephone | 404-550-0564
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Fax | 678-344-2956
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Provider Business Mailing Address
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Address Line | PO BOX 955
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City | SNELLVILLE
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State | GA
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Zip | 30078-0955
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Country | US
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Telephone | 404-550-0564
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Fax | 678-344-2956
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Authorized Official
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Title or Position | OWNER
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Name | ALETHA JENNIFER CLARK
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Credential | PHD, LPC
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Telephone | 404-550-0564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1658-R
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License Number State | GA
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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 | 004805
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License Number State | GA
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