| Doctor Name: | MS. MARY JOSEPHINE CLARK |
| NPI Number: | 1063482578 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A., L.P.X. |
| License Number: | 6401005964 |
| Business Practice Address: | 455 Garland St Se Kentwood, MI - 495487669 |
| Business Phone Number: | 6162629749 |
| Business Fax Number: | 6165313009 |
| Mailing Address: | 942 52nd St Se, Suite 101 KENTWOOD |
| State: | MI |
| Postal Code: | 495086005 |
| Phone Number: | 6162629749 |
| Fax Number: | 6165313009 |
| NPI Enumeration Date: | 01/25/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 6401005964 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |