Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | LPC006586 | GA |
Y | 103TC1900X | Counseling Psychologist |
NPI | 1003123407 |
---|---|
Provider Name | Christina Clarke |
First Address | Atlanta, GA 30341-1274 |
Second Address | Atlanta, GA 30341-1274 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2010 |
Last Update Date | 12/02/2021 |