Doctor Name: | MONICA ANNETTE CLARK |
NPI Number: | 1043511660 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | E.1000027 |
Business Practice Address: | 441 E 8th St Lima, OH - 458042482 |
Business Phone Number: | 4192213072 |
Business Fax Number: | 4195495670 |
Mailing Address: | 441 E 8th St, LIMA |
State: | OH |
Postal Code: | 458042482 |
Phone Number: | 4192213072 |
Fax Number: | 4195495670 |
NPI Enumeration Date: | 11/12/2010 |
NPI Last Update Date: | 10/25/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | E.1000027 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |