| Doctor Name: | JENNIFER K CLARK |
| NPI Number: | 1992088611 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 0810004270 |
| Business Practice Address: | 43130 Amberwood Plz Suite 140 South Riding, VA - 201524105 |
| Business Phone Number: | 7035427770 |
| Business Fax Number: | |
| Mailing Address: | 43130 Amberwood Plz, Suite 140 SOUTH RIDING |
| State: | VA |
| Postal Code: | 201524105 |
| Phone Number: | 7035427770 |
| Fax Number: | |
| NPI Enumeration Date: | 09/20/2011 |
| NPI Last Update Date: | 12/12/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 0810004270 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |