| NPI | 1730492281 |
|---|---|
| Other Name | SHANNA CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VT 068.0134262) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 7511) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2010-07-26 |
| Last Update Date | 2020-12-08 |