| NPI | 1770839748 |
|---|---|
| Former Name | JENNIFER ALISON CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA LMHC10000618) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA LMHC10000618) |
| Enumeration Date | 2012-07-27 |
| Last Update Date | 2025-01-15 |