Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 5317 | OH |
Y | 103TC0700X | Clinical Psychologist | 5317 | OH |
NPI | 1003817081 |
---|---|
Provider Name | Christina Clark |
First Address | Worthington, OH 43085-4135 |
Second Address | Worthington, OH 43085-4135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 28/09/2012 |