Individual provider · Type 1 NPI

Antionette K. Clark

Mental Health Counselor · Vicksburg, MS

NPI number 1588943161 Active

Practice location

3444 Wisconsin Ave
Vicksburg, MS 39180-5331

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XNone listed

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About NPI 1588943161

Antionette K. Clark's National Provider Identifier is 1588943161, issued on Aug 12, 2011. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Vicksburg, MS. The record was last updated on Aug 12, 2011.