| NPI | 1346633187 |
|---|---|
| Former Name | THELMA STALEY CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401008178) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 00049452) |
| Enumeration Date | 2015-03-17 |
| Last Update Date | 2016-07-15 |