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General NPI Number Information
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NPI Number | 1881752764
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Entity Type | Individual
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Provider Name | JOAN MARIE CLARK LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 1603 STEVENS AVE
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City | LOUISVILLE
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State | KY
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Zip | 40205-1087
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Country | US
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Telephone | 502-451-5955
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Fax | 502-451-5925
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Provider Business Mailing Address
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Address Line | 1919 CAMPUS PLACE
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City | LOUISVILLE
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State | KY
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Zip | 40299
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Country | US
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Telephone | 502-253-4924
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Fax | 502-489-5750
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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 | 34004222A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1444
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License Number State | KY
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