| Doctor Name: | CHRISTINA CLARK |
| NPI Number: | 1003817081 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 5317 |
| Business Practice Address: | 666 High St Suite 200-d Worthington, OH - 430854135 |
| Business Phone Number: | 6144308920 |
| Business Fax Number: | 6144308920 |
| Mailing Address: | 666 High St, Suite 200-d WORTHINGTON |
| State: | OH |
| Postal Code: | 430854135 |
| Phone Number: | 6144308920 |
| Fax Number: | 6144308920 |
| NPI Enumeration Date: | 08/02/2005 |
| NPI Last Update Date: | 09/28/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 5317 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |