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Contact Information

JENISE T CLARK, LPC
715 BRADLEY DR
FAYETTEVILLE, GA30214-2030
 Phone: 770-358-5252
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Counselor

101Y00000X
 

Addiction (Substance Use Disorder)

101YA0400X
Indicates primary specialty

NPI Profile & details for JENISE T CLARK · (Female)

NPI Number 1851880926
Status Active
Credentials LPC (Licensed Professional Counselor)
Entity Individual
Enumeration date 05/04/2018
Last updated 03/22/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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