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General NPI Number Information
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NPI Number | 1316866940
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Entity Type | Individual
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Provider Name | JESSICA CLARK
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Gender | Female
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Dates
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Enumeration Date | 07/15/2026
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Last Update Date | 07/15/2026
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Provider Practice Location Address
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Address Line | 200 SURREY CT
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City | WESTMINSTER
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State | MD
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Zip | 21157-6528
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Country | US
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Telephone | 410-596-9821
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Fax |
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Provider Business Mailing Address
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Address Line | 1004 LITTLESTOWN PIKE STE C
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City | WESTMINSTER
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State | MD
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Zip | 21157-3027
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Country | US
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Telephone | 717-465-0943
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Fax | 443-952-2710
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LGA3450
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License Number State | MD
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