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Provider Information for 1821484494


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Mrs. LECRETIA WILLIAMS CLARK M.ED, LPC


Sex: Female

NPI: 1821484494
Last Updated: 2016-09-02
Certification Date:

Details

NameValue
NPI1821484494
Enumeration Date2015-04-10
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 303 N MADISON ST
CORINTH, MS 38834-5072
United States

Phone: 662-286-9883 | Fax:662-284-9836
 
Primary Practice Address 2705 HIGHWAY 51 S
HERNANDO, MS 38632-2634
United States

Phone: 662-449-1971 | Fax:662-449-1974
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YM0800X - Counselor - Mental HealthMS3389