| Doctor Name: | CHRISTINA CLARKE |
| NPI Number: | 1003123407 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S., ED.S, LPC, NCC |
| License Number: | LPC006586 |
| Business Practice Address: | 770 Village Square Dr Stone Mountain, GA - 300833380 |
| Business Phone Number: | 4042988998 |
| Business Fax Number: | 4042987658 |
| Mailing Address: | 770 Village Square Dr, STONE MOUNTAIN |
| State: | GA |
| Postal Code: | 300833380 |
| Phone Number: | 4042988998 |
| Fax Number: | 4042987658 |
| NPI Enumeration Date: | 09/07/2010 |
| NPI Last Update Date: | 02/13/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LPC006586 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |