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1104030899
TINA MICHELLE CLARK
CHEHALIS, WA
NPI
1104030899
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor Mental Health
(Licence: WA RC00049995)
Enumeration Date
2007-05-10
Last Update Date
2007-07-08
Business Address
TINA MICHELLE CLARK
135 W MAIN ST
CHEHALIS, WA 98532-4817
Phone number: 360-748-6696
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Mailing Address
TINA MICHELLE CLARK
1313 FERRIER RD
WINLOCK, WA 98596-9330
Phone number:
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