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:
Certification Date:
Details
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NPI | 1821484494 | ||||||||
Enumeration Date | 2015-04-10 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | NO | ||||||||
Status | Active | ||||||||
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 | ||||||||
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