| NPI | 1649831207 |
|---|---|
| Former Name | JESSICA LEA CLARKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH cdca.168660) |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2019-06-25 |