| NPI | 1770839748 |
|---|---|
| Former Name | JENNIFER ALISON CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA LMHC10000618) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: MA LMHC10000618) |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: MA LMHC10000618) | |
| 101YM0800X Counselor, Mental Health (Licence: LMHC10000618) | |
| 106H00000X Marriage & Family Therapist (Licence: MA LMFT10000092) | |
| 261QM0850X Clinic/Center, Adult Mental Health (Licence: MA LMHC10000618) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA LMHC10000618) | |
| Enumeration Date | 2012-07-27 |
| Last Update Date | 2025-09-30 |