| Doctor Name: | JEANETTA CLARK |
| NPI Number: | 1003298639 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 1803 N. Jackson St Centerstone Of Tennessee Tullahoma, TN - 37388 |
| Business Phone Number: | 6154636643 |
| Business Fax Number: | |
| Mailing Address: | 3605 Chasewood Dr Sw Apt 5, HUNTSVILLE |
| State: | AL |
| Postal Code: | 358055180 |
| Phone Number: | 2054276509 |
| Fax Number: | |
| NPI Enumeration Date: | 06/19/2015 |
| NPI Last Update Date: | 06/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YS0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |